Comparative analysis on renal and cardiovascular outcomes of antidiabetic treatment in chronic kidney disease patients - A systematic review and network meta-analysis
Comparing diabetes drugs head-to-head across trials, this network meta-analysis found SGLT2 inhibitors gave the strongest kidney and heart-failure protection in patients with diabetes and CKD, with GLP-1 agonists next; both lowered death rates while DPP-4 inhibitors added little.
Background
Type 2 diabetes with chronic kidney disease markedly raises cardiovascular and kidney-failure risk, but comparative effectiveness data across newer antidiabetic classes are scarce. This network meta-analysis compared SGLT2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors on cardiorenal outcomes.
Study design
Twenty-six randomized controlled trials published 2014-2024, enrolling 143,296 participants with type 2 diabetes and CKD, were pooled in a frequentist network meta-analysis ranking treatments by P-score for major adverse cardiovascular events, composite renal outcomes, and all-cause mortality.
Key findings
SGLT2 inhibitors were most effective for composite renal events (P-score 0.94), eGFR decline >40% or renal replacement therapy (0.99), MACE (0.93), and heart failure (1.00), followed by GLP-1 receptor agonists. GLP-1 receptor agonists were most effective for myocardial infarction (0.87), macroalbuminuria (0.86), and stroke (0.83). Both classes reduced all-cause mortality (0.83); DPP-4 inhibitors showed limited benefit.
Clinical implications
SGLT2 inhibitors, followed by GLP-1 receptor agonists, provide the strongest cardiorenal protection in diabetic CKD, with SGLT2 inhibitors preferred where heart failure and kidney-function decline dominate the risk profile.
Category
Research
Source
Diabetes, Obesity & Metabolism
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