Introduction
Approximately 850 million adults live with chronic kidney disease worldwide. Globally, chronic kidney disease results in 1.2 million deaths every year, with cardiovascular diseases being the leading cause of death.1 Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been the mainstay of medical treatment for adults with chronic kidney disease for decades. However, individuals with chronic kidney disease carry a substantial residual risk of complications, including progression to kidney failure and cardiovascular events.2
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors were initially developed as diabetes treatment medications. They subsequently proved to have protective effects on the cardiovascular system and on the kidney in adults who have type 2 diabetes, heart failure, or both.3–5 More recently, two trials have shown large reductions in risks of kidney failure and death in addition to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for adults with chronic kidney disease with and with no diabetes.6 7 One meta-analysis similarly showed cardiovascular and kidney benefits with SGLT-2 inhibitors, but was limited to large trials only and included only four trials that had adults with chronic kidney disease, and did not account for variable risks of cardiovascular and kidney complications across individuals when presenting absolute treatment effects.8
To inform evidence-based practice guidelines stratified by risk, we systematically reviewed all available randomised trial evidence regarding the efficacy and safety of SGLT-2 inhibitors for adults with chronic kidney disease, irrespective of type 2 diabetes status (box 1).
Linked articles in this BMJ Rapid Recommendation cluster
Research article: Zou X, Shi Q, Vandvik PO, et al. Sodium- glucose co-transporter-2 inhibitors in patients with chronic kidney disease with or without type 2 diabetes: systematic review and meta-analysis. BMJ Med 2024;3:e001009
Systematic review and meta-analysis of all available randomised trials that assessed sodium-glucose co-transporter-2 (SGLT-2) inhibitors
Practice article: Agarwal A, Zeng X, Li S. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline. BMJ 2024; 387:e080257
A clinical practice guideline from the rapid recommendations process
MAGICapp version (https://app.magicapp.org/%23/guideline/EezrQj)
Expanded version of the results with multilayered recommendations, evidence summaries, and decision aids for use across electronic devices