Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Diabetic Nephropathy: A Review of Clinical Effectiveness

Key Message

Four systematic reviews and five randomized controlled trials on the clinical effectiveness of sodium glucose cotransporter 2 (SGLT2) inhibitors for treatment of adult patients with type 2 diabetes and chronic kidney disease were identified.The risks for all-cause death, cardiovascular death, myocardial infarction, and stroke were less with SGLT2 inhibitor compared with placebo, however, the between group differences were not always statistically significant. The risk for heart failure was statistically significantly less with SGLT2 inhibitors compared with placebo.The risks for renal death, and end stage kidney disease was less with SGLT2 inhibitor compared with placebo, however the between group differences were not always statistically significant. The risks for composite renal outcomes were statistically significantly less with SGLT2 inhibitor compared with placebo. There were inconsistencies in the findings with respect to risk of acute kidney injury.Albuminuria, doubling serum creatinine, glycated hemoglobin, fasting blood glucose, and body weight were less with SLGT2 inhibitors compared with placebo, however, the between group differences were not always statistically significant. Findings with respect to estimated glomerular filtration rate were inconsistent.The risks of genital infections and diabetic ketoacidosis were generally higher with SLGT2 inhibitors compared with placebo, though results for diabetic ketoacidosis were not always statistically significant. There were inconsistencies in the findings with respect to adverse events such as hypoglycemia, amputation, and fracture. Findings however need to be interpreted with caution considering the limitations (such as lack of details regarding patient characteristics in some studies, lack of details regarding background treatments used, variability in study quality, and limited generalizability).