Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysis
BackgroundThis study aims to evaluate the incidence of hyperkalemia and serum potassium levels associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i), renin‐angiotensin‐aldosterone system inhibitors (RAASi) and concurrent use of these medications in individuals with diabetic...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1462965/full |
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| author | Yahui Yuan Yahui Yuan Yahui Yuan Chun Chen Yuping Lin Yehao Luo Yehao Luo Yehao Luo Zhaojun Yang Zhaojun Yang Zhaojun Yang Jingyi Guo Jingyi Guo Jingyi Guo Qiaoyun Liu Qiaoyun Liu Qiaoyun Liu Lu Sun Guanjie Fan Guanjie Fan Guanjie Fan |
| author_facet | Yahui Yuan Yahui Yuan Yahui Yuan Chun Chen Yuping Lin Yehao Luo Yehao Luo Yehao Luo Zhaojun Yang Zhaojun Yang Zhaojun Yang Jingyi Guo Jingyi Guo Jingyi Guo Qiaoyun Liu Qiaoyun Liu Qiaoyun Liu Lu Sun Guanjie Fan Guanjie Fan Guanjie Fan |
| author_sort | Yahui Yuan |
| collection | DOAJ |
| description | BackgroundThis study aims to evaluate the incidence of hyperkalemia and serum potassium levels associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i), renin‐angiotensin‐aldosterone system inhibitors (RAASi) and concurrent use of these medications in individuals with diabetic kidney disease (DKD).MethodsA comprehensive systematic search was performed in EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and PubMed database, covering studies up to March 2024. Relevant randomized controlled trials (RCT) included adults with DKD who were treated with SGLT-2i and RAASi or their combination, with a minimum follow-up duration of 12 weeks. The primary outcomes assessed were the incidence of hyperkalemia and serum potassium levels were the primary outcomes assessed. The surface under the cumulative ranking curves (SUCRA) was utilized for ranking purposes.ResultsThe study included 36 trials, encompassing 45,120 participants, comparing various interventions. SGLT-2i (SUCRA = 88.5%) was found to significantly reduce the risk of hyperkalemia. In contrast, the combination of ACEI/ARB + MRA (SUCRA = 5.7%) increased the risk of hyperkalemia. However, when SGLT-2i was added to the ACEI/ARB + MRA regimen, the incidence of hyperkalemia was found to decrease. Subgroup analyses on MRA showed that ACEI/ARB + spironolactone posed the highest risk of hyperkalemia. ACEI/ARB + SGLT-2i mitigated serum potassium level.ConclusionSGLT-2i was effective in reducing the incidence of hyperkalemia incidence, whereas a combination of ACEI/ARB and MRA might elevate the incidence of hyperkalemia in individuals with DKD.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42024552810. |
| format | Article |
| id | doaj-art-7f31471a799543aaaa3b97ae6685a8e0 |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-7f31471a799543aaaa3b97ae6685a8e02025-01-27T09:26:02ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-01-011510.3389/fphar.2024.14629651462965Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysisYahui Yuan0Yahui Yuan1Yahui Yuan2Chun Chen3Yuping Lin4Yehao Luo5Yehao Luo6Yehao Luo7Zhaojun Yang8Zhaojun Yang9Zhaojun Yang10Jingyi Guo11Jingyi Guo12Jingyi Guo13Qiaoyun Liu14Qiaoyun Liu15Qiaoyun Liu16Lu Sun17Guanjie Fan18Guanjie Fan19Guanjie Fan20The Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaWangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaBackgroundThis study aims to evaluate the incidence of hyperkalemia and serum potassium levels associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i), renin‐angiotensin‐aldosterone system inhibitors (RAASi) and concurrent use of these medications in individuals with diabetic kidney disease (DKD).MethodsA comprehensive systematic search was performed in EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and PubMed database, covering studies up to March 2024. Relevant randomized controlled trials (RCT) included adults with DKD who were treated with SGLT-2i and RAASi or their combination, with a minimum follow-up duration of 12 weeks. The primary outcomes assessed were the incidence of hyperkalemia and serum potassium levels were the primary outcomes assessed. The surface under the cumulative ranking curves (SUCRA) was utilized for ranking purposes.ResultsThe study included 36 trials, encompassing 45,120 participants, comparing various interventions. SGLT-2i (SUCRA = 88.5%) was found to significantly reduce the risk of hyperkalemia. In contrast, the combination of ACEI/ARB + MRA (SUCRA = 5.7%) increased the risk of hyperkalemia. However, when SGLT-2i was added to the ACEI/ARB + MRA regimen, the incidence of hyperkalemia was found to decrease. Subgroup analyses on MRA showed that ACEI/ARB + spironolactone posed the highest risk of hyperkalemia. ACEI/ARB + SGLT-2i mitigated serum potassium level.ConclusionSGLT-2i was effective in reducing the incidence of hyperkalemia incidence, whereas a combination of ACEI/ARB and MRA might elevate the incidence of hyperkalemia in individuals with DKD.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42024552810.https://www.frontiersin.org/articles/10.3389/fphar.2024.1462965/fulldiabetic kidney diseaserenin-angiotensin-aldosterone system inhibitorshyperkalemiaSGLT-2inetwork meta-analysis |
| spellingShingle | Yahui Yuan Yahui Yuan Yahui Yuan Chun Chen Yuping Lin Yehao Luo Yehao Luo Yehao Luo Zhaojun Yang Zhaojun Yang Zhaojun Yang Jingyi Guo Jingyi Guo Jingyi Guo Qiaoyun Liu Qiaoyun Liu Qiaoyun Liu Lu Sun Guanjie Fan Guanjie Fan Guanjie Fan Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysis Frontiers in Pharmacology diabetic kidney disease renin-angiotensin-aldosterone system inhibitors hyperkalemia SGLT-2i network meta-analysis |
| title | Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysis |
| title_full | Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysis |
| title_fullStr | Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysis |
| title_full_unstemmed | Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysis |
| title_short | Incidence of hyperkalemia RAASi and SGLT-2i treatment in individuals with diabetic kidney disease: a systematic review and network meta-analysis |
| title_sort | incidence of hyperkalemia raasi and sglt 2i treatment in individuals with diabetic kidney disease a systematic review and network meta analysis |
| topic | diabetic kidney disease renin-angiotensin-aldosterone system inhibitors hyperkalemia SGLT-2i network meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1462965/full |
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