■评估非类固醇盐皮质激素受体拮抗剂(ns-MRAs)和钠-葡萄糖协同转运蛋白2抑制剂(SGLT2is)在糖尿病肾病(DKD)患者中的疗效和安全性。
■使用PubMed进行了系统的文献检索,Embase和WebofScience开始到2024年1月20日。选择比较DKD中ns-MRA和SGLT2is的随机对照试验(RCT)。感兴趣的疗效结果包括肾脏特异性复合结果,心血管(CV)特异性复合结局,终末期肾病(ESKD),和总死亡率。我们还调查了安全性结果,包括急性肾损伤(AKI)和高钾血症。
■共包括10项随机临床试验,其中35,786名患者应用各种治疗。SGLT2is(SUCRA99.84%)在肾脏保护方面具有潜在的优势。SGLT2is(RR1.41,95CI1.26至1.57)和ns-MRA(RR1.17,95%CI1.08至1.27)与肾脏特异性综合结局显着低于安慰剂。关于CV特异性复合结局和ESKD的减少,SGLT2is(SUCRA91.61%;91.38%)在发挥心肾保护作用方面具有潜在的优势。关于CV特异性综合结局(RR1.27,95CI1.09至1.43)和ESKD(RR1.43,95CI1.20至1.72),与安慰剂相比,SGLT2显著降低了风险。关于降低总死亡率,SGLT2is(SUCRA83.03%)在延缓死亡方面具有潜在优势。关于总死亡率,与安慰剂相比,SGLT2is具有与安慰剂相当的效果(RR1.27,95CI1.09至1.43),以降低总死亡率的风险。为了减少AKI,ns-MRA(SUCRA63.58%)具有潜在优势。SGLT2is具有与安慰剂相当的效果(RR1.24,95CI1.05至1.46),以降低AKI的风险。为了减少高钾血症,SGLT2is(SUCRA93.12%)具有潜在的优越性。SGLT2is具有与安慰剂相当的效果(RR1.24,95CI1.05至1.46),以降低AKI的风险。关于减少高钾血症,与安慰剂相比,nsMRA(RR1.2495CI0.39至3.72)和SGLT2is(RR1.0195CI0.40至3.02)未显示显著获益。
■关于疗效和安全性结果,SGLT2is可能被推荐作为最大化肾脏和心血管保护的治疗方案。DKD高钾血症的风险最小。
■https://www.crd.约克。AC.英国/普华永道/,标识符CRD42023458613。
UNASSIGNED: To evaluate the efficacy and safety of non-steroid mineralocorticoid receptor antagonists (ns-MRAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) in patients with diabetic kidney disease (DKD).
UNASSIGNED: Systematic literature searches were performed using PubMed, Embase and Web of Science encompassing inception until January 20, 2024. Randomized control trials (RCTs) comparing ns-MRAs and SGLT2is in DKD were selected. The efficacy outcomes of interest included kidney-specific composite outcome, cardiovascular (CV)-specific composite outcome, end-stage kidney disease (ESKD), and overall mortality. We also investigated safety outcomes, including acute kidney injury (AKI) and hyperkalemia.
UNASSIGNED: A total of 10 randomized clinical trials with 35,786 patients applying various treatments were included. SGLT2is (SUCRA 99.84%) have potential superiority in kidney protection. SGLT2is (RR 1.41, 95%CI 1.26 to 1.57) and ns-MRAs (RR 1.17, 95% CI 1.08 to 1.27) were associated with significantly lower kidney-specific composite outcome than the placebo. Regarding the reduction in CV-specific composite outcome and ESKD, SGLT2is (SUCRA 91.61%; 91.38%) have potential superiority in playing cardiorenal protection. Concerning the CV-specific composite outcome (RR 1.27, 95%CI 1.09 to 1.43) and ESKD (RR 1.43, 95%CI 1.20 to 1.72), SGLT2is significantly reduced the risks compared to placebo. Regarding the reduction in overall mortality, SGLT2is (SUCRA 83.03%) have potential superiority in postponing mortality. Concerning the overall mortality, SGLT2is have comparable effects (RR 1.27, 95%CI 1.09 to 1.43) with placebo to reduce the risk of overall mortality compared to placebo. For AKI reduction, ns-MRAs (SUCRA 63.58%) have potential superiority. SGLT2is have comparable effects (RR 1.24, 95%CI 1.05 to 1.46) with placebo to reduce the risk of AKI. For hyperkalemia reduction, SGLT2is (SUCRA 93.12%) have potential superiority. SGLT2is have comparable effects (RR 1.24, 95%CI 1.05 to 1.46) with placebo to reduce the risk of AKI. Concerning hyperkalemia reduction, nsMRAs (RR 1.24 95%CI 0.39 to 3.72) and SGLT2is (RR 1.01 95%CI 0.40 to 3.02) did not show significant benefit compared to placebo.
UNASSIGNED: Concerning the efficacy and safety outcomes, SGLT2is may be recommended as a treatment regimen for maximizing kidney and cardiovascular protection, with a minimal risk of hyperkalemia in DKD.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/, identifier CRD42023458613.