背景:已知钠葡萄糖协同转运蛋白-2(SGLT-2)抑制剂可降低各种心力衰竭(HF)人群的住院率和心血管死亡率,可能通过增强水和钠的排泄。然而,有人担心与使用它们相关的急性肾损伤(AKI)风险.这项荟萃分析旨在阐明SGLT-2抑制剂对各种HF患者AKI风险的影响。
方法:本研究使用PubMed进行了全面的文献检索,EMBASE,科克伦图书馆,和clinicaltrials.gov在2024年1月1日之前发表的研究。使用随机效应或固定效应模型分析数据,以95%置信区间(CI)估计总体相对风险(RR)。
结果:我们的分析包括来自16项随机对照试验的25,172例HF患者。与安慰剂相比,SGLT-2抑制剂治疗导致AKI进展风险降低28%(RR0.72,95%CI0.61-0.85,p<0.0001),无低血压(RR1.21,95%CI0.87-1.70,p=0.26)和低血容量(RR2.26,95%CI:0.70-7.33,p=0.17)的风险增加.值得注意的是,SGLT-2抑制剂显著降低特定亚组的AKI,包括射血分数降低的HF患者(RR0.59,95%CI0.43-0.80,p=0.0007),那些接受依帕列净(RR0.70,95%CI0.57-0.88,p=0.002)或达帕列净(RR0.74,95%CI0.57-0.98,p=0.04)治疗的患者,在随访至少1年的研究中(RR0.67,95%CI0.55-0.82,p=0.0001),以及65岁或以上的患者(RR0.72,95%CI0.61-0.85,p<0.0001)。
结论:无论射血分数环境如何(慢性和急性),使用SGLT-2抑制剂均未增加AKI的发生率,SGLT-2抑制剂的类型,或患者年龄。
BACKGROUND: Sodium glucose cotransporter-2 (SGLT-2) inhibitors are known to reduce hospitalization and cardiovascular mortality in various heart failure (HF) populations, potentially through enhanced excretion of water and sodium. However, there are concerns regarding the risk of acute kidney injury (AKI) associated with their use. This meta-analysis aimed to unravel the effects of SGLT-2 inhibitors on risk of AKI in a variety of patients with HF.
METHODS: This study conducted a comprehensive literature search using PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov for studies published up to January 1, 2024. Data were analyzed using both random-effects or fixed-effects models to estimate the overall relative risk (RR) with a 95% confidence interval (CI).
RESULTS: Our analysis included 25,172 patients with HF from 16 randomized controlled trials. Treatment with SGLT-2 inhibitors led to a 28% reduction in the risk of AKI progression compared to placebo (RR 0.72, 95% CI 0.61-0.85, p<0.0001), without an increased risk of hypotension (RR 1.21, 95% CI 0.87-1.70, p = 0.26) and
hypovolemia (RR 2.26, 95% CI: 0.70-7.33, p = 0.17). Notably, SGLT-2 inhibitors significantly decreased AKI in specific subgroups, including patients with HF with reduced ejection fraction (RR 0.59, 95% CI 0.43-0.80, p = 0.0007), those treated with empagliflozin (RR 0.70, 95% CI 0.57-0.88, p = 0.002) or dapagliflozin (RR 0.74, 95% CI 0.57-0.98, p = 0.04), in studies with a follow-up of at least 1 year (RR 0.67, 95% CI 0.55-0.82, p = 0.0001), and in patients aged 65 years or older (RR 0.72, 95% CI 0.61-0.85, p < 0.0001).
CONCLUSIONS: Use of SGLT-2 inhibitors did not increase the incidence of AKI regardless of the ejection fraction environment (chronic and acute), type of SGLT-2 inhibitors, or patient age.