The Effectiveness And Safety Of SGLT2 Inhibitors In Subjects With Diabetes And Chronic Kidney Disease: A Meta-Analysis

Objects: To evaluate the effectiveness and safety of SGLT2 inhibitors in subjects with diabetes and chronic kidney disease(CKD).Methods: We searched for randomized clinical trials(RCTs)that assessed the effects of SGLT2 inhibitors in subjects with diabetes and CKD in PubMed,Embase,Web Of Science,The Cochrane library,CNKI,VIP and Wanfang database,the retrieval time was up to September-30-2018,We screened the literature,evaluated the quality of literature and extracted required date,Then we used Stata 15.0 software performe Meta-analysis.Results:Finally 9 studies with 9409 participants were included,Meta-analysis showed that in subjects with diabetes and CKD,SGLT2 inhibitors reduced HbAlc[WMD=-0.26,95%CI(-0.38,-0.14),p=0.000],FPG [SMD=-0.51,95%CI(-0.77,-0.26),p=0.000],BW [WMD=-1.61,95%CI(-1.83,-1.38),p=0.000],SBP [WMD=-4.12,95%CI(-4.98,-3.25),p=0.000],DBP [WMD=-2.17,95%CI(-2.76,-1.58),p=0.000];decreased eGFR [WMD=-1.92,95%CI(-3.69,-0.16),p=0.033],increased BUN[SMD=0.42,95%CI(0.26,0.58),p=0.000] and Cr [SMD=0.17,95%CI(0.04,0.29),p=0.011];reduced the incidence of total adverse events [RR=0.98,95%CI(0.97,1.00),p=0.045] and all-cause mortality [RR=0.74,95%CI(0.59,0.91),p=0.005],increased the rate of genital infection [RR=2.87,95%CI(2.22,3.72),p=0.000],but had no significant effect on the incidence of hypoglycemia[RR=1.00,95%CI(0.94,1.07),p=0.999],urinary tract infection [RR =0.97,95%CI(0.88,1.07),p=0.560]and the adverse events associated with decreased volume [RR=1.18,95%CI(0.97,1.42),p=0.090].Subgroup analysis showed: the effectiveness of SGLT2 inhibitors decreased with the progression of renal function from CKD2 to CKD3;In the short term of treatment cycle renal function decreased,and with the prolongation of treatment cycle,renal function remained;In patients with stage CKD3,the use of SGLT2 inhibitors increased the rate of genital infection.The incidence of adverse events was not significantlyassociated with the progression of CKD stage.Conclusion: In patients with stage CKD2,SGLT2 inhibitors is effective and safe;In patients with stage CKD3,the effectiveness decreased,renal function remained with prolongation of treatment cycle,and the rate of genital infection increased;In patients with stage CKD4 and above,due to limited data,SGLT2 inhibitors is not recommended.A large number of multicenter trials are still needed to discuss the effectiveness and safety of SGLT2 inhibitors in subjects with diabetes and CKD.