BY-Pooja Prakash Rathod, Kirti Patle.-
Volume 1 Issue 1 (May-Aug) 2024, Article 10 (pp.89-99)
Key Points
Question: In patients with chronic kidney disease (CKD), how does the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors, compared to standard care, impact the progression of renal function decline?
Findings: In this systematic review, analyzing multiple cohort studies and randomized clinical trials, the use of SGLT2 inhibitors in CKD patients was associated with a slower progression of renal function decline compared to standard care. Patients on SGLT2 inhibitors demonstrated a statistically significant reduction in the rate of decline in glomerular filtration rate (GFR) and a lower incidence of end-stage renal disease (ESRD).
Meaning: SGLT2 inhibitors appear to be effective in slowing the progression of renal function decline in CKD patients, suggesting their potential role as a key therapeutic option in managing CKD.
Abstract
Importance:
The progressive decline in renal function among patients with chronic kidney disease (CKD) is a pressing clinical concern, contributing significantly to morbidity and mortality worldwide. The potential of sodium-glucose cotransporter-2 (SGLT2) inhibitors to decelerate this decline offers a promising therapeutic avenue that warrants comprehensive evaluation.
Objective:
This systematic review aims to critically assess the impact of SGLT2 inhibitors on the progression of renal function decline in patients with CKD, as compared to standard care. The review focuses on treatment efficacy, encompassing patient populations across various CKD stages, with an emphasis on the long-term preservation of renal function and the prevention of end-stage renal disease (ESRD).
Evidence Review:
A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, and Cochrane Library, covering publications from January 2010 to December 2023. Additional sources, such as reference lists from selected articles, were also examined. Studies included in this review were randomized controlled trials (RCTs) and observational cohort studies that met predefined eligibility criteria. The quality of included studies was assessed using the Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies.
Findings:
A total of 25 studies, encompassing over 15,000 participants, were included in the review. The evidence consistently demonstrated that patients receiving SGLT2 inhibitors exhibited a slower rate of decline in glomerular filtration rate (GFR) compared to those receiving standard care. Notably, the relative risk of progression to ESRD was significantly lower in the SGLT2 inhibitor group. The included studies varied in design and population, but the consistency of findings across high-quality RCTs and robust cohort studies underscores the therapeutic benefit of SGLT2 inhibitors in mitigating renal function decline in CKD patients.
Conclusions and Relevance:
The findings of this systematic review suggest that SGLT2 inhibitors are effective in slowing the progression of renal function decline in CKD patients, thereby reducing the risk of ESRD. These results support the integration of SGLT2 inhibitors into clinical practice as a key component of CKD management, with implications for improving patient outcomes and reducing the burden of renal disease.
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