钠-葡萄糖协同转运体 2 抑制剂对慢性肾脏病心力衰竭事件的影响:系统回顾和荟萃分析。

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2024-07-16 DOI:10.1093/ehjcvp/pvae003
Marieta P Theodorakopoulou, Maria-Eleni Alexandrou, Alexandros Tsitouridis, Vasileios Kamperidis, Eva Pella, Andrew Xanthopoulos, Antonios Ziakas, Filippos Triposkiadis, Vassilios Vassilikos, Aikaterini Papagianni, Pantelis Sarafidis
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引用次数: 0

摘要

目的:钠-葡萄糖协同转运体 2(SGLT-2)抑制剂可显著降低糖尿病和高血压患者因心力衰竭(HF)住院的风险;但对慢性肾脏病(CKD)患者的研究结果并不一致。我们旨在进行一项荟萃分析,探讨 SGLT-2 抑制剂对 CKD 患者以及基线肾功能所定义的亚组中 HF 事件的影响:在主要电子数据库中进行了系统检索。纳入的随机对照试验提供了有关 SGLT-2 抑制剂对基线或按基线估计肾小球滤过率(eGFR)分层的亚组中流行性 CKD 患者的主要结局(因 HF 恶化而住院或急诊的时间)影响的数据。荟萃分析纳入了 12 项研究(n = 89,191 名参与者)。在 CKD 患者中,与安慰剂相比,SGLT-2 抑制剂治疗可将 HF 事件风险降低 32%(危险比 [HR] 0.68;95%CI 0.63-0.73)。SGLT-2抑制剂对高血压事件的降低作用在eGFR患者中更为明显 结论:SGLT-2抑制剂的治疗可降低高血压事件的发生风险:使用 SGLT-2 抑制剂治疗可显著减少慢性肾脏病患者的高血压事件。这些发现可能会改变晚期 CKD 患者高血压事件的预防前景。PROSPERO 注册号:CRD42022382857。
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Effects of sodium-glucose co-transporter 2 inhibitors on heart failure events in chronic kidney disease: a systematic review and meta-analysis.

Aims: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors significantly reduce the risk for hospitalizations for heart failure (HF) in patients with diabetes, and HF; findings in patients with chronic kidney disease (CKD) are not uniform. We aimed to perform a meta-analysis exploring the effect of SGLT-2 inhibitors on HF events in patients with CKD and across subgroups defined by baseline kidney function.

Methods and results: A systematic search in major electronic databases was performed. Randomized controlled trials (RCTs) providing data on the effect of SGLT-2 inhibitors on the primary outcome, time to hospitalization or urgent visit for worsening HF in patients with prevalent CKD at baseline or across subgroups stratified by baseline estimated glomerular-filtration-rate (eGFR) were included. Twelve studies (n = 89,191 participants) were included in the meta-analysis. In patients with CKD, treatment with SGLT-2 inhibitors reduced the risk for HF events by 32% compared to placebo [hazard ratio (HR) 0.68; 95% confidence interval (CI) 0.63-0.73]. Reduction in HF events with SGLT-2 inhibitors was more prominent in patients with eGFR <60 ml/min/1.73 m2 (HR 0.68; 95% CI 0.62-0.74) than in those with eGFR ≥60 ml/min/1.73 m2 (HR 0.76; 95% CI 0.69-0.83). Subgroup analysis according to type of SGLT-2 inhibitor showed a consistent treatment effect across all studied agents (p-subgroup-analysis = 0.44). Sensitivity analysis including data from studies including only diabetic patients showed an even more pronounced effect in eGFR subgroup <60 ml/min/1.73 m2 (HR 0.62; 95% CI 0.54-0.70).

Conclusion: Treatment with SGLT-2 inhibitors led to a significant reduction in HF events in patients with CKD. Such findings may change the landscape of prevention of HF events in patients with advanced CKD. PROSPERO Registration number CRD42022382857.

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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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