J Korean Diabetes.  2020 Sep;21(3):105-115. 10.4093/jkd.2020.21.3.105.

The Effect of Long-Term Sodium-Glucose Cotransporter 2 Inhibitor Treatment on Renal Function in Patients with Type 2 Diabetes

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
  • 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 3Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
  • 4Division of Nephrology, Department of Internal Medicine, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
  • 5Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
  • 6Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
  • 7Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
  • 8Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
  • 9Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

Chronic kidney disease commonly develops in patients with type 2 diabetes mellitus (T2DM) and is the most common cause of end-stage renal disease and related cardiovascular complications. Meanwhile, despite the current standard of care that includes optimized glucose control and the use of single-agent blockade of the renin-angiotensin-aldosterone system (RAAS), patients with T2DM remain at increased risk for premature death and complications due to cardiorenal causes. Recent studies using sodiumglucose cotransporter 2 (SGLT2) inhibitors have shown not only glucose lowering effects, but also a reduction in blood pressure, weight loss, and lower cardiovascular risk. Regarding renal outcomes, the use of SGLT2 inhibitors slows the progression of kidney disease compared to placebo when added to standard care. However, concern has been raised that currently available SGLT2 inhibitors in Korea may also be associated with improved renal outcomes during long-term treatment. As a result, we aimed to evaluate the effect of long-term SGLT2 inhibitor treatment on renal function in patients with T2DM using meta-analysis.

Keyword

Chronic kidney disease; Diabetes mellitus; type 2; Meta-analysis; Sodium-glucose cotransporter 2 inhibitor

Figure

  • Fig. 1. Effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on (A) estimated glomerular filtration rate (eGFR), and (B) change in eGFR from baseline. SD, standard deviation; IV, inverse variance; CI, confidence interval.

  • Fig. 2. Results for patients with estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. Effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on (A) eGFR, and (B) change of eGFR from baseline. SD, standard deviation; IV, inverse variance; CI, confidence interval.

  • Fig. 3. Effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on change in (A) HbA1c, (B) body weight, (C) systolic blood pressure, and (D) diastolic blood pressure. SD, standard deviation; IV, inverse variance; CI, confidence interval.

  • Fig. 4. Effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on (A) hypoglycemia, (B) urinary tract infection, (C) genital infection, (D) volume depletion, (E) acute kidney injury, and (F) diabetic ketoacidosis. M-H, Mantel-Haenszel; CI, confidence interval.


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