Aim

This study investigated the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on renal outcomes in Asian patients with type 2 diabetes mellitus (T2DM).

Materials and methods

We searched Medline, EMBASE, and the Cochrane Library to identify randomized controlled trials published up to April 2020 that compared SGLT2 inhibitors with placebo or active comparator and reported any renal outcomes in Asian patients with T2DM. Random effects models and inverse variance weighting were used to calculate relative risks with 95% confidence intervals (CIs).

Results

We included 14 studies, totaling 3792 patients, in the analysis. In the short term, SGLT2 inhibitors significantly slowed estimated glomerular filtration rate (eGFR) decline (MD: 0.80; 95% CI: 0.66 to 0.94; p < 0.00001) and reduced Scr levels (SMD: − 0.17; 95% CI: − 0.23 to − 0.10; p < 0.00001) as compared with the control groups. The SGLT2 inhibitor group also had an advantage over the control group in lowering uric acid (UA) (SMD: − 1.2; 95% CI: − 1.30 to − 1.11; p < 0.00001). There was no significant difference in urinary albumin creatinine ratio (UACR) reduction between the SGLT2 inhibitor and control groups (MD: − 8.87; 95% CI: − 19.80 to 2.06; p = 0.11). However, dapagliflozin does appear to reduce albuminuria (p = 0.005). Lastly, SGLT2 inhibitors increased the incidence of adverse events (AEs) related to renal function (OR: 1.90; 95% CI: 1.24 to 2.91; p = 0.003), but did not increase the incidence of renal impairment (OR: 0.85; 95% CI: 0.40 to 1.81; p = 0.68).

Conclusion

The use of SGLT2 inhibitors in Asian patients with T2DM can help delay the decline of eGFR and reduce Scr and UA. Although SGLT2 inhibitors have no overall advantage in reducing albuminuria, dapagliflozin does appear to reduce albuminuria, and while they may increase the occurrence of AEs related to renal function, they do not increase the incidence of renal impairment.

中文翻译：

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SGLT2 抑制剂治疗亚洲 2 型糖尿病患者的肾脏结局：随机对照试验的系统评价和荟萃分析

目的

本研究调查了钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂对亚洲 2 型糖尿病 (T2DM) 患者肾脏结局的影响。

材料和方法

我们检索了 Medline、EMBASE 和 Cochrane 图书馆，以确定截至 2020 年 4 月发表的随机对照试验，这些试验将 SGLT2 抑制剂与安慰剂或活性对照药进行了比较，并报告了亚洲 T2DM 患者的任何肾脏结局。随机效应模型和反方差加权用于计算具有 95% 置信区间 (CI) 的相对风险。

结果

我们在分析中纳入了 14 项研究，共计 3792 名患者。短期内，SGLT2 抑制剂显着减缓估计的肾小球滤过率 (eGFR) 下降（MD：0.80；95% CI：0.66 至 0.94；p  < 0.00001）并降低 Scr 水平（SMD：- 0.17；95% CI：- 0.23至 - 0.10；p  < 0.00001) 与对照组相比。SGLT2抑制剂组在降低尿酸（UA）方面也优于对照组（SMD：- 1.2；95% CI：- 1.30至- 1.11；p  < 0.00001）。SGLT2 抑制剂组和对照组之间的尿白蛋白肌酐比 (UACR) 降低没有显着差异（MD：- 8.87；95% CI：- 19.80 至 2.06；p  = 0.11）。然而，达格列净似乎确实可以减少白蛋白尿（p = 0.005）。最后，SGLT2 抑制剂增加了与肾功能相关的不良事件 (AE) 的发生率（OR：1.90；95% CI：1.24 至 2.91；p  = 0.003），但并未增加肾功能损害的发生率（OR：0.85；95 % CI：0.40 至 1.81；p  = 0.68）。

结论

在亚洲 T2DM 患者中使用 SGLT2 抑制剂有助于延缓 eGFR 的下降并降低 Scr 和 UA。尽管 SGLT2 抑制剂在减少白蛋白尿方面没有整体优势，但达格列净似乎确实可以减少白蛋白尿，虽然它们可能会增加与肾功能相关的 AE 的发生，但不会增加肾功能损害的发生率。