Comparison of the renal outcomes of novel antidiabetic agents in type 2 diabetes with chronic kidney disease: a network meta-analysis
A network meta-analysis of 20 randomized trials in over 80,000 patients found that SGLT2 inhibitors—led by dapagliflozin—provide the most consistent kidney protection in type 2 diabetes with chronic kidney disease, while DPP-4 inhibitors conferred no renal benefit.
Background
Patients with type 2 diabetes and chronic kidney disease (CKD) have several newer drug classes available—DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors—but their comparative renal effects had not been clearly ranked.
Study design
The authors searched PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov through July 2025 for randomized trials of at least 24 weeks in adults with type 2 diabetes and CKD, then conducted a Bayesian network meta-analysis of composite renal outcome, eGFR, and urinary albumin-to-creatinine ratio (UACR), grading certainty with GRADE. Twenty RCTs enrolling 80,670 participants were included.
Key findings
Dapagliflozin 10 mg showed the greatest reduction in the composite renal outcome (OR 0.55; 95% CI 0.42–0.72; high-certainty evidence), followed by canagliflozin, empagliflozin, efpeglenatide, sotagliflozin, semaglutide, and dulaglutide. Canagliflozin most strongly reduced UACR, no agent significantly changed eGFR, and DPP-4 inhibitors conferred no renal benefit.
Clinical implications
SGLT2 inhibitors should be prioritized for kidney protection in diabetic CKD, while recognizing meaningful heterogeneity between agents. Certainty was high for placebo-controlled comparisons but lower for indirect head-to-head estimates, underscoring the need for drug-specific evaluation.
Category
Research
Source
Diabetes, Obesity & Metabolism
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