Renoprotective effects and safety of sodium-glucose cotransporter 2 inhibitors in diabetic chronic kidney disease: A systematic review and meta-analysis

Chronic kidney disease (CKD) is a major global health burden characterized by progressive loss of renal function and high cardiovascular morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed as glucose-lowering agents, have demonstrated pleiotropic metabolic and cardiorenal benefits. However, previous evidence syntheses have not fully clarified the magnitude of metabolic, hemodynamic, renal surrogate, and safety effects specifically in patients with diabetic CKD.

A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to December 2025. Randomized controlled trials (RCTs) evaluating SGLT2 inhibitors in patients with diabetic CKD were included. Outcomes were prespecified and grouped as primary renal surrogate marker outcomes (eGFR and UACR), secondary metabolic and hemodynamic outcomes (glycated hemoglobin, body weight, and blood pressure indicators), and safety outcomes (urinary tract infection and volume depletion-related adverse events). Meta-analyses were performed using RevMan 5.3 and R version 4.4.2 software.