A meta-analysis pooled six studies and 451 patients with autosomal dominant polycystic kidney disease treated with SGLT2 inhibitors. The question matters because these drugs have transformed outcomes in diabetic and non-diabetic chronic kidney disease, and ADPKD patients have been largely excluded from the trials that established that.
The results do not support extrapolation. Compared with each patient's own pre-treatment eGFR slope, initiation was associated with an attenuation of decline of 0.65 mL/min/1.73 m² per year, interval 0.05 to 1.26 — statistically significant, and a before-and-after comparison rather than a controlled one. Against patients receiving non-SGLT2 inhibitor therapy, the difference was 2.12 with an interval from -8.13 to 12.38, which carries no information. Total kidney volume change showed no difference either, at -31.31 mL per year with an interval from -184 to +121.
No major safety concerns emerged. The authors' own conclusion is that current evidence is insufficient, limited by small samples, predominantly observational designs and substantial heterogeneity — and that is the right reading. ADPKD is a disease of cyst growth rather than of glomerular hyperfiltration, so mechanistic extrapolation from diabetic kidney disease is not obviously safe either.
- 451 patients across six mostly observational studies — a thin evidence base
- The significant result is a before-and-after slope comparison, not a controlled one
- The controlled comparison interval spans -8 to +12; it excludes nothing
- Total kidney volume, the disease-specific endpoint, showed no change
- No safety signal, but also no demonstrated benefit
The statistics, in plain English
The two comparisons answer different questions. Against a patient's own prior slope, any regression to the mean or change in co-treatment appears as drug effect — which is why that comparison reached significance and the controlled one did not. When a before-and-after result is positive and the controlled result is null, the controlled result is the one to believe.
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