What are Benefits and Risks of SGLT2 Inhibitors in Diabetic Kidney Disease?
A new study published in the journal of Frontiers in Endocrinology showed that patients with diabetic kidney disease (DKD) benefit greatly from Sodium-glucose cotransporter-2 (SGLT2) inhibitors, but there is also a higher risk of vaginal infections and diabetic ketoacidosis when compared to control groups.
One of the main causes of chronic kidney disease and end-stage renal disease globally is diabetic kidney disease, which is a gradual loss of renal function in diabetes. Proteinuria, hypoalbuminemia, edema, and nephrotic syndrome are all brought on by glomerular damage, which also causes glomerular filtration rate to drop even in cases of mild albuminuria.
By decreasing sodium and glucose reabsorption in the proximal tubule, SGLT2 inhibitors lower blood glucose without the need for insulin and with a little risk of hypoglycemia. Additionally, they lower blood pressure, uric acid, and weight, and clinical studies indicate that they may protect the kidneys and heart. To assess the effectiveness and safety of SGLT2 inhibitors in DKD patients, this study does a meta-analysis.
This research looked through the Web of Science, Embase, and PubMed databases to find relevant RCTs published up until July 2024. Risk ratios (RR) or weighted mean differences (WMD) with 95% CI were used to summarize effect sizes. Stata was used for statistical analysis and a total of 24463 patients from 15 meta-analysis were included.
The findings demonstrated that SGLT2 inhibitor intervention could lower the estimated glomerular filtration rate (WMD=−2.47; 95% CI: −3.18, −1.76), glycated hemoglobin (WMD=−0.27; 95% CI: −0.38, −0.17), systolic blood pressure (WMD=−4.09; 95% CI: −4.97 to -3.21), diastolic blood pressure (WMD=−2.47; 95% CI: −3.06 to −1.88), and diastolic blood pressure (WMD=−4.09).
Furthermore, the incidence of bone fracture, hypoglycemia, urinary tract infections, and total adverse events did not significantly vary between the SGLT2 inhibitor and control groups. When compared to the control group, the SGLT2 inhibitor group experienced a greater incidence of diabetic ketoacidosis and genital infections.
Overall, this study supports the beneficial effects of SGLT2 inhibitors on blood pressure, glycated hemoglobin levels, and estimated glomerular filtration rate in individuals with diabetic kidney disease. However, compared to the control group, the SGLT2 inhibitor group experienced a greater incidence of diabetic ketoacidosis and genital infections.
Reference:
Guo, Y., Gao, W., Li, S., An, X., & Liu, Z. (2025). Efficacy and safety of sodium-glucose cotransporter 2 inhibitors in the treatment of diabetic kidney disease: a meta-analysis. Frontiers in Endocrinology, 16(1596888),. https://doi.org/10.3389/fendo.2025.1596888
