SGLT-2 inhibitors for adults with chronic kidney disease: a clinical practice guideline
An international clinical practice guideline published in BMJ recommends SGLT-2 inhibitors for adults with chronic kidney disease across all risk strata, with strong recommendations for those at high or very high risk of progression and weak recommendations for lower-risk groups, irrespective of type 2 diabetes status.
Background
Few therapies slow kidney disease progression and improve long-term prognosis in adults with chronic kidney disease. SGLT-2 inhibitors have demonstrated cardiovascular and kidney benefits in adults with chronic kidney disease both with and without type 2 diabetes, but existing guidance did not fully account for stratified treatment effects across all risk groups.
Key recommendations
An international panel of patients, clinicians, and methodologists used the GRADE approach and KDIGO risk strata to issue recommendations applicable to all adults with chronic kidney disease regardless of type 2 diabetes status: weak recommendations in favor of SGLT-2 inhibitors for those at low and moderate risk, and strong recommendations in favor for those at high and very high risk of progression and complications. Guidance was informed by a linked systematic review and pairwise meta-analysis of 13 trials including 29,614 participants.
Clinical implications
Among individuals at very high risk, moderate-to-high certainty evidence shows SGLT-2 inhibitors decrease all-cause and cardiovascular mortality, heart failure hospitalization, kidney failure, and non-fatal myocardial infarction and stroke. SGLT-2 inhibitors were associated with little or no effect on harms such as acute kidney injury requiring dialysis, fractures, amputations, ketoacidosis, or genital infections. To apply the recommendations, clinicians should identify adults with chronic kidney disease and risk-stratify them using eGFR and albuminuria, supported by interactive decision aids.
Category
Guidelines
Source
BMJ
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