Efficacy and safety of sodium-glucose cotransporter-2 inhibitors in patients with chronic kidney disease: a systematic review and meta-analysis

Chu Hsuan Shiau, Li Yun Tsau, Chih Chin Kao, Yu Ching Peng, Chyi Huey Bai, Jeng‑Cheng ‑C Wu, Wen Hsuan Hou

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


Purpose: Owing to the pharmacological mechanism, sodium–glucose cotransporter 2 inhibitors (SGLT2is) may be less effective in patients with reduced renal functions, but no systematic review or meta-analysis addressed chronic kidney disease (CKD) patients specifically. We aimed to assess the efficacy and safety of SGLT2is in CKD patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials. Mean difference (MD) were pooled for the decline of glomerular filtration rate (eGFR) and change in urine albumin-to-creatinine ratio (uACR). Hazard ratio (HR) and rate ratio (RR) were pooled for composite of renal outcomes and adverse effects. Results: Thirty articles were identified. Overall MD in rate of eGFR decline was 0.02 (P = 0.05), with a borderline significant difference favoring SGLT2is, while the change in uACR from baseline was − 141.34 mg/g and hazard ratio of composite renal outcomes was 0.64 significantly favoring SGLT2is. Subgroup analyses showed that the long-term renal function, participants with baseline macroalbuminuria, and stage 4 CKD patients had significantly slower eGFR decline rate in SGLT2is compared to the placebo group. Risks of genital mycotic infection and ketoacidosis were significantly higher among the SGLT2is group than placebo. Conclusion: For CKD patients, no matter diabetic or non-diabetic, our study showed potential renoprotective effects favoring SGLT2is in overall and long-term phase, and in patients with macroalbuminuria or stage 4 CKD. However, only slight increased risk of adverse effects among the SGLT2is group is observed. Therefore, we concluded that in CKD patients, prescribing SGLT2is was safe and had renal benefits.

Original languageEnglish
Pages (from-to)1359-1381
Number of pages23
JournalInternational Urology and Nephrology
Issue number4
Publication statusAccepted/In press - 2023


  • Adverse effects
  • Chronic kidney disease (CKD)
  • Composite renal outcome
  • Meta-analysis
  • Sodium–glucose cotransporter 2 inhibitors (SGLT2is)
  • Systematic review

ASJC Scopus subject areas

  • Nephrology
  • Urology


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