Impact of SGLT2 Inhibitors on Cardiovascular and Renal Outcomes According to Baseline Renal Function: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: The effect of sodium-glucose co-transporter-2 (SGLT-2) inhibitors on cardiovascular and renal outcomes has not been specifically examined across baseline kidney function groups in a meta-analysis including the most recent trials. We conducted a systematic review and meta-analysis of randomized control trials (RCTs) with SGLT-2 inhibitors in patients with and without CKD. Methods: We performed a PubMed/Medline search of randomized, placebocontrolled, event-driven outcome trials of SGLT-2 inhibitors versus active or placebo control in patients with and without diabetes from inception to February 1, 2022. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73m2. The primary outcome was cardiovascular death. Secondary outcomes included hospitalization for heart failure, major adverse cardiovascular events (MACE), progression to kidney failure, and all-cause mortality. The relative risk (RR) was estimated using a random-effects model. Results: Eleven RCTs were identified and included in this meta-analysis (77541 patients, including 28515 patients with CKD). Use of an SGLT-2 inhibitor was associated with a lower incidence of cardiovascular death in patients with CKD, compared with placebo: RR 0.87 (95% CI 0.79-0.95). Use of an SGLT-2 inhibitor was associated with a lower incidence of heart failure in patients with CKD, compared with placebo: RR 0.65 (95% CI 0.59-0.70). Risk reduction with SGLT-2 inhibitors was more important among patients with CKD compared with patients without CKD (p for interaction 0.03). SGLT-2 inhibitors were associated with a lower incidence of CKD progression among patients with pre-existing CKD, compared with placebo: RR 0.74 (95% CI 0.63-0.88). SGLT-2 inhibitors were also associated with a lower incidence of MACE and death from any cause among patients with CKD, compared with placebo. Conclusions: SGLT-2 inhibitors offer strong protection against cardiovascular and renal outcomes in patients with CKD. These results strongly advocate in favor of using these agents in patients with CKD. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.041 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".