Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision Analysis
Sodium-glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1a), and non-steroidal mineralocorticoid receptor antagonists (ns-MRA) are promising treatments for chronic kidney disease. This umbrella review of network meta-analyses evaluated their effects on card...
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2024-12-01
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| author | Ioannis Bellos Smaragdi Marinaki Pagona Lagiou Vassiliki Benetou |
| author_facet | Ioannis Bellos Smaragdi Marinaki Pagona Lagiou Vassiliki Benetou |
| author_sort | Ioannis Bellos |
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| description | Sodium-glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1a), and non-steroidal mineralocorticoid receptor antagonists (ns-MRA) are promising treatments for chronic kidney disease. This umbrella review of network meta-analyses evaluated their effects on cardiovascular outcomes, kidney disease progression, and adverse events, using the TOPSIS method to identify the optimal intervention based on P-scores. A total of 19 network meta-analyses and 44 randomized controlled trials involving 86,150 chronic kidney disease patients were included. Compared to placebo, SGLT2i were associated with reduced risks of cardiovascular events [Hazard ratio (HR): 0.776, 95% confidence intervals (CI): 0.727–0.998], kidney disease progression (HR: 0.679, 95% CI: 0.629–0.733), acute kidney injury (HR: 0.873, 95% CI: 0.773–0.907), and serious adverse events (HR: 0.881, 95% CI: 0.847–0.916). GLP1a and ns-MRA were also associated with significant reductions in cardiovascular and kidney-specific composite outcomes. Indirect evidence showed that SGLT2i demonstrated a lower risk of kidney disease progression compared to GLP1a (HR: 0.826, 95% CI: 0.716–0.952) and ns-MRA (HR: 0.818, 95% CI: 0.673–0.995), representing the best intervention across all endpoints. In conclusion, while SGLT2i, GLP1a, and ns-MRA all reduce cardiovascular and kidney disease risks in chronic kidney disease, SGLT2i appears to provide the most favorable balance of efficacy and safety. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
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| series | Biomolecules |
| spelling | doaj-art-b7c3e12ac2354335b3688c4038f387962025-01-24T13:24:57ZengMDPI AGBiomolecules2218-273X2024-12-011513910.3390/biom15010039Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision AnalysisIoannis Bellos0Smaragdi Marinaki1Pagona Lagiou2Vassiliki Benetou3Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 115 27 Athens, GreeceDepartment of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 115 27 Athens, GreeceDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 115 27 Athens, GreeceDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 115 27 Athens, GreeceSodium-glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1a), and non-steroidal mineralocorticoid receptor antagonists (ns-MRA) are promising treatments for chronic kidney disease. This umbrella review of network meta-analyses evaluated their effects on cardiovascular outcomes, kidney disease progression, and adverse events, using the TOPSIS method to identify the optimal intervention based on P-scores. A total of 19 network meta-analyses and 44 randomized controlled trials involving 86,150 chronic kidney disease patients were included. Compared to placebo, SGLT2i were associated with reduced risks of cardiovascular events [Hazard ratio (HR): 0.776, 95% confidence intervals (CI): 0.727–0.998], kidney disease progression (HR: 0.679, 95% CI: 0.629–0.733), acute kidney injury (HR: 0.873, 95% CI: 0.773–0.907), and serious adverse events (HR: 0.881, 95% CI: 0.847–0.916). GLP1a and ns-MRA were also associated with significant reductions in cardiovascular and kidney-specific composite outcomes. Indirect evidence showed that SGLT2i demonstrated a lower risk of kidney disease progression compared to GLP1a (HR: 0.826, 95% CI: 0.716–0.952) and ns-MRA (HR: 0.818, 95% CI: 0.673–0.995), representing the best intervention across all endpoints. In conclusion, while SGLT2i, GLP1a, and ns-MRA all reduce cardiovascular and kidney disease risks in chronic kidney disease, SGLT2i appears to provide the most favorable balance of efficacy and safety.https://www.mdpi.com/2218-273X/15/1/39chronic kidney diseasesglt2glp1finerenonenetwork meta-analysis |
| spellingShingle | Ioannis Bellos Smaragdi Marinaki Pagona Lagiou Vassiliki Benetou Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision Analysis Biomolecules chronic kidney disease sglt2 glp1 finerenone network meta-analysis |
| title | Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision Analysis |
| title_full | Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision Analysis |
| title_fullStr | Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision Analysis |
| title_full_unstemmed | Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision Analysis |
| title_short | Comparative Efficacy and Safety of Cardio-Renoprotective Pharmacological Interventions in Chronic Kidney Disease: An Umbrella Review of Network Meta-Analyses and a Multicriteria Decision Analysis |
| title_sort | comparative efficacy and safety of cardio renoprotective pharmacological interventions in chronic kidney disease an umbrella review of network meta analyses and a multicriteria decision analysis |
| topic | chronic kidney disease sglt2 glp1 finerenone network meta-analysis |
| url | https://www.mdpi.com/2218-273X/15/1/39 |
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