医学
肾功能
荟萃分析
危险系数
肾脏疾病
内科学
心力衰竭
糖尿病
子群分析
安慰剂
随机对照试验
2型糖尿病
置信区间
内分泌学
病理
替代医学
作者
Marieta Theodorakopoulou,Maria‐Eleni Alexandrou,Alexandros Tsitouridis,Vasileios Kamperidis,Eva Pella,Αndrew Xanthopoulos,Antonios Ziakas,Filippos Triposkiadis,Vassilios Vassilikos,Αikaterini Papagianni,Pantelis A. Sarafidis
出处
期刊:European Heart Journal - Cardiovascular Pharmacotherapy
[Oxford University Press]
日期:2024-01-13
标识
DOI:10.1093/ehjcvp/pvae003
摘要
Sodium-glucose co-transporter 2 (SGLT-2) inhibitors significantly reduce the risk for hospitalizations for heart failure (HF) in patients with diabetes, and HF; findings in patients with chronic kidney disease (CKD) are not uniform. We aimed to perform a meta-analysis exploring the effect of SGLT-2 inhibitors on HF events in patients with CKD and across subgroups defined by baseline kidney function.A systematic search in major electronic databases was performed. Randomized controlled trials providing data on the effect of SGLT-2 inhibitors on the primary outcome, time to hospitalization or urgent visit for worsening HF in patients with prevalent CKD at baseline or across subgroups stratified by baseline estimated glomerular-filtration-rate (eGFR) were included. Twelve studies (n = 89,191 participants) were included in the meta-analysis. In patients with CKD, treatment with SGLT-2 inhibitors reduced the risk for HF events by 32% compared to placebo (hazard ratio [HR] 0.68; 95%CI 0.63-0.73). Reduction in HF events with SGLT-2 inhibitors was more prominent in patients with eGFR < 60 ml/min/1.73m2 (HR 0.68; 95%CI 0.62-0.74) than in those with eGFR ≥ 60 ml/min/1.73m2 (HR 0.76; 95%CI 0.69-0.83). Subgroup analysis according to type of SGLT-2 inhibitor showed a consistent treatment effect across all studied agents (p-subgroup-analysis = 0.44). Sensitivity analysis including data from studies including only diabetic patients showed an even more pronounced effect in eGFR subgroup < 60 ml/min/1.73m2 (HR 0.62; 95%CI 0.54-0.70).Treatment with SGLT-2 inhibitors led to a significant reduction in HF events in patients with CKD. Such findings may change the landscape of prevention of HF events in patients with advanced CKD. PROSPERO Registration number: CRD42022382857.
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