SGLT2 inhibitors ‘best choice’ for reducing AKI risk vs othe
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For patients with type 2 diabetes, SGLT2 inhibitors conferred a lower risk of developing AKI than use of GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors, according to a network meta-analysis of clinical trials.

Little is known about the comparative effects of dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), or sodium glucose cotransporter-2 (SGLT2) inhibitors on risk of AKI. This study aimed to compare the effects of these three novel classes of glucose-lowering drugs on AKI risk in patients with or without type 2 diabetes, by network meta-analysis of event-driven cardiovascular or kidney outcome trials.

Researchers systematically searched electronic databases up to September 2020, and included 20 event-driven cardiovascular or kidney outcome trials (18 trials included patients with type 2 diabetes only, and two trials included patients with or without type 2 diabetes). A network meta-analysis using a frequentist approach was performed to compare the effects of DPP-4 inhibitors, GLP-1RAs, or SGLT2 inhibitors on risk of AKI, and estimate the probability for each intervention as the safest one. The primary analysis included 18 trials with type 2 diabetes only, and a secondary analysis included 20 trials.

Results:
-- In the 18 trials with a total of 2051 AKI events (range: 1–300) among 156,690 patients with type 2 diabetes only, the network meta-analysis showed that SGLT2 inhibitors were associated with a lower risk of AKI compared with placebo, whereas both DPP-4 inhibitors and GLP-1RAs had neutral effects on risk of AKI.

-- Moreover, SGLT2 inhibitors were significantly associated with a lower risk in AKI than both GLP-1RAs and DPP-4 inhibitors.

-- SGLT2 inhibitors have the highest probability of being the safest intervention (84%). The results were similar in the secondary analysis.

Conclusively, current evidence indicates that SGLT2 inhibitors have a lower risk of AKI than both DPP-4 inhibitors and GLP-1RAs.

Source: https://cjasn.asnjournals.org/content/16/1/70
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