- Design
- Systematic review and meta-analysis of randomised trials
- Population
- 17 trials, 29,192 people with diabetic chronic kidney disease
- Primary outcome
- eGFR and urinary albumin-creatinine ratio
- Effect
- eGFR +0.25 mL/min/1.73 m2 (95% CI -0.08 to 0.57); volume depletion RR 1.36 (1.16 to 1.59)
This meta-analysis pooled 17 randomised trials with 29,192 participants who had diabetic chronic kidney disease. SGLT2 inhibitors lowered HbA1c by 0.40 percentage points, weight by 1.36 kg and systolic blood pressure by about 3 mm Hg.
On the renal surrogate markers there was no significant difference: eGFR changed by 0.25 mL/min/1.73 m2 (95% CI -0.08 to 0.57) and the albumin-creatinine ratio by -31.55 mg/g with a very wide interval (-137.21 to 74.12). Urinary tract infection was not significantly increased (RR 1.20, 0.94 to 1.54), but volume depletion events were (RR 1.36, 1.16 to 1.59).
The neutral surrogate result should not be read as no kidney benefit. The authors themselves point to large outcome trials showing long-term cardiorenal protection. A short-term eGFR dip and a pooled albuminuria estimate with heterogeneous trials are poor measures of that benefit.
- Do not stop an SGLT2 inhibitor because eGFR or albuminuria has not improved on follow-up tests.
- Review volume status and diuretic doses when starting, particularly in older or frail patients.
- Expect modest falls in weight and systolic pressure alongside the HbA1c effect.
- Treat this as a surrogate-marker analysis; outcome trials remain the basis for prescribing.
Why it matters
It challenges the habit of judging an SGLT2 inhibitor's kidney value by short-term lab trends.
Don't overread it
The analysis pooled surrogate endpoints from mixed trials and was not designed to test kidney failure or death.
The statistics, in plain English
A confidence interval that crosses zero, as for eGFR and albuminuria here, means the data are compatible with no difference, not that a difference has been excluded. The albuminuria interval is so wide it tells you little.
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