The Role of SGLT2 Inhibitors in Preventing the Progression of Chronic Kidney Disease in Patients with Type 2 DM: A Systematic Review

Abstract

Background. Type 2 diabetes mellitus is the most common type of diabetes and is the leading cause of chronic kidney disease globally. Currently, the medications recommended for treatment are not fully effective for treating CKD. Recent findings from the DAPA-CKD and EMPA-KIDNEY clinical trials have revealed that SGLT-2 inhibitors offer significant benefits in improving kidney function and preventing the progression of kidney disease.

Objective. This review aims to evaluate the efficacy and safety of SGLT2 inhibitors in delaying CKD progression and reducing dialysis dependency in patients with type 2 diabetes.

Methods. This research is a systematic literature study using PRISMA 2020 Protocols. Article searches were carried out in PubMed, Cochrane Library, Sage Journals, and Europe PMC, covering the period from January 2019 to March 2024. The search strategy used the keywords “SGLT2 Inhibitor” AND “Prevention” AND “Chronic Kidney Disease” AND “Type 2 Diabetes”. Articles that met the criteria were assessed for risk of bias using RoB2.

Results. From 7 articles with a total of 15,927 participants included in this systematic review, the overall risk of bias was low. Patients with type 2 diabetes and CKD who received SGLT2 inhibitors had a significantly lower risk of renal composite outcomes compared to placebo (e.g. HR 0.70, 95% CI 0.59-0.82). A modest initial decrease in eGFR was observed in the SGLT2i group compared to placebo, followed by stabilization over time.

Conclusion. SGLT2 inhibitors can be proposed as an effective treatment option for renal protection in patients with type 2 diabetes mellitus and chronic kidney disease, with moderate certainty of evidence from consistent RCT findings