先前的证据表明,钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)介导的尿葡萄糖排泄(UGE)似乎随着肾小球滤过率的降低而降低。因此,我们进行了系统评价和荟萃分析,以比较不同肾功能水平个体中SGLT2i介导的UGE.
我们在PubMed中进行了系统搜索,Medline,Embase,Cochrane中央控制试验登记册,和ClinicalTrial.gov从成立到2021年5月。包括SGLT2i的临床研究以及预定义的不同肾功能水平的UGE变化的报告。结果表示为具有95%置信区间(CI)的合并效应大小。使用随机效应模型来计算合并效应大小。
总共,纳入了8项符合条件的研究.在按肾功能分层的亚组之间,治疗后的UGE水平存在显着差异(亚组差异P<0.001),随着肾功能受损的严重程度逐渐降低。始终如一,对于肾功能正常的个体,SGLT2i治疗前后UGE的变化也随着肾功能受损的严重程度而降低[67.52g/天(95CI:55.58至79.47g/天),52.41克/天(95CI:38.83至65.99克/天)用于轻度肾功能损害的个体,35.11g/天(95CI:19.79至50.43g/天)用于中度肾功能损害的个体,和13.53g/天(95CI:7.20至19.86g/天)的个体严重肾功能损害;P<0.001的亚组差异]。
SGLT2i介导的UGE是肾功能依赖性的,随着肾功能损害的程度降低。
Previous evidence suggested that sodium-glucose cotransporter 2 inhibitor (SGLT2i)-mediated urinary glucose excretion (UGE) appeared to be reduced with a decrease in glomerular filtration rate. Thus, we conducted a systematic review and meta-analysis to compare SGLT2i-mediated UGE among individuals with different levels of renal function.
We conducted systematic searches in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov from inception to May 2021. Clinical studies of SGLT2i with reports of UGE changes in predefined different levels of renal function were included. The results were expressed as pooled effect sizes with 95% confidence interval (CI). A random-effects model was used to calculate the pooled effect sizes.
In total, eight eligible studies were included. Significant differences were observed in the post-treatment UGE level among subgroups stratified by renal function (P <0.001 for subgroup difference), which were gradually decreased along with the severity of impaired renal function. Consistently, changes in UGE before and after SGLT2i treatment were also decreased along with the severity of impaired renal function [67.52 g/day (95%CI: 55.58 to 79.47 g/day) for individuals with normal renal function, 52.41 g/day (95%CI: 38.83 to 65.99 g/day) for individuals with mild renal function impairment, 35.11 g/day (95%CI: 19.79 to 50.43 g/day) for individuals with moderate renal function impairment, and 13.53 g/day (95%CI: 7.20 to 19.86 g/day) for individuals with severe renal function impairment; P <0.001 for subgroup differences].
SGLT2i-mediated UGE was renal function dependent, which was decreased with the extent of renal function impairment.