Premium
Acute kidney injury with sodium‐glucose co‐transporter‐2 inhibitors: A meta‐analysis of cardiovascular outcome trials
Author(s) -
Gilbert Richard E.,
Thorpe Kevin E.
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13754
Subject(s) - medicine , acute kidney injury , kidney disease , hazard ratio , placebo , randomized controlled trial , meta analysis , type 2 diabetes , diabetes mellitus , intensive care medicine , adverse effect , relative risk , confidence interval , endocrinology , pathology , alternative medicine
Three, multicentre, large‐scale, randomized, placebo‐controlled trials of cardiovascular outcomes with sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors have each shown substantial reductions in rates of hospitalization for heart failure and progression of chronic kidney disease in people with type 2 diabetes. However, safety concerns remain for this ostensibly paradigm‐shifting drug class. In particular, the US Food and Drug Administration has highlighted the risk of acute kidney injury (AKI), a condition associated with high morbidity and mortality. To investigate this further, we conducted a meta‐analysis of the three trials to compare the frequency of AKI adverse event reports between participants treated with placebo and those who had received an SGLT2 inhibitor. Rather than an increase, we noted a consistent and robust reduction in the likelihood of AKI among those participants who had been randomized to receive an SGLT2 inhibitor (hazard ratio 0.66, 95% confidence interval 0.54‐0.80). We further noted that the reports of AKI were similar in frequency to those of kidney disease progression. The caveats of the non‐adjudicated reporting of AKI in the trials notwithstanding, these data suggest that SGLT2 inhibitors may protect vulnerable patients with type 2 diabetes from AKI and that prospective studies to evaluate this additional aspect of kidney protection are warranted.