Effects Of Sodium-Glucose Cotransporter-2 Inhibitors On Renal Function In Patients With Type 2 Diabetes Mellitus And Chronic Kidney Disease: A Network Meta-Analysis

Objective:A network meta-analysis was conducted to evaluate the effects of sodium-glucose cotransporter-2 inhibitors on renal function in patients with type 2 diabetes mellitus and chronic kidney disease.Methods:Pub Med,EMbase,Web of Science,Cochrane Library,CNKI,wanfang and VIP databases were searched from inception up until 5 March 2021.Randomized controlled trials that met the inclusion criteria were screened out and the risk of bias was assessed using the Cochrane Collaboration risk of bias tool.The endpoints were Δestimate glomerular filtration rate,Δurinary albumin creatinine ratio,incidence of urinary tract infection,incidence of any adverse events,incidence of serious adverse events and incidence of treatment discontinuation.Stata16.0software was used for statistical analysis.Results:Empagliflozin 25 mg[MD=-240.43,95%CI(-414.13,-66.73)],dapagliflozin 10 mg[MD=-94.15,95%CI(-111.72,-76.59)],and canagliflozin 100mg[MD=-193.25,95%CI(-279.16,-107.34)]reduced urine albumin-creatinine ratio levels compared with controls.Empagliflozin 25 mg,canagliflozin 100 mg and danagliflozin 10 mg induced a significant decline in urine albumin-creatinine ratio compared to dapagliflozin 5 mg.Compared with controls,luseogliflozin2.5mg[MD=-3.50,95%CI(-6.65,-0.35)],bexagliflozin 20mg[MD=-3.48,95%CI:(-6.57,-0.39)],and dapagliflozin 10mg[MD=-94.15,95%CI(-111.72,-76.59)] reduced the estimated glomerular filtration rate.In terms of safety,ertugliflozin 5mg reduced the risk of urinary tract infection.Compared with controls,empagliflozin 10 mg and 25 mg,and canagliflozin 100 mg reduced the risk of any adverse events while canagliflozin 100 mg reduced the risk of serious adverse events.Dapagliflozin 10 mg had a lower risk of treatment discontinuation.Conclusion:Sodium-glucose cotransporter-2 inhibitors have different effects on urine albumin-creatinine ratio and estimated glomerular filtration rate,but the overall safety is good.However,additional randomised clinical trials are needed to validate these findings.