Abstract
Introduction: Chronic kidney disease (CKD) is among the fastest causes of mortality worldwide, associated with cardiovascular disease and diabetes. This study aimed to evaluate the impact of empagliflozin use on cardiovascular outcomes in patients with CKD.
Materials and Methods: This systematic review and meta-analysis was conducted according to PRISMA guidelines. Electronic databases, including PubMed, Scopus, Web of Science, Cochrane, and the Google Scholar search engine, were searched until June 5, 2023. Data were analyzed using STATA software version 14. A P< 0.05 indicated the significance of statistical tests.
Results: Eight clinical trial studies with a total sample of 39620 participants were evaluated in this meta-analysis. Compared with placebo, empagliflozin administration in CKD patients lowered the risk of cardiovascular death or first heart failure hospitalization by 28% (OR: 0.72; 95% CI: 0.66, 0.80), cardiovascular death by 25% (OR: 0.75; 95% CI: 0.63, 0.88), first heart failure hospitalization by 30% (OR: 0.70; 95% CI: 0.63, 0.77), total (first and recurrent) heart failure hospitalizations by 28% (OR: 0.72; 95% CI: 0.65, 0.81), and all-cause mortality by 20% (OR: 0.80; 95% CI: 0.69, 0.93). However, it demonstrated no significant effect on reducing the risk of composite kidney outcome (OR: 0.75; 95% CI: 0.55, 1.02). In addition, long-term empagliflozin use (over 105 weeks) caused a drastic reduction in cardiovascular death risk in these patients. The lowering effect of empagliflozin on cardiovascular risk decreased as the patient’s age increased.
Conclusion: Empagliflozin declined the risk of cardiovascular death or first heart failure hospitalization, cardiovascular death, first heart failure hospitalization, total (first and recurrent) heart failure hospitalization, and all-cause mortality in CKD patients.
Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD42023438798).