The impact of SGLT2 inhibitors on renal outcomes in patients with type 2 diabetes and chronic kidney disease: systematic review and meta-analysis

Objective: To analyze and evaluate the impact of SGLT2 inhibitors on the renal outcomes of patients with type 2 diabetes mellitus and chronic kidney disease, and to provide evidence-based basis for clinical rational treatment. Methods: Relevant literatures on the impact of SGLT2 inhibitors on the renal outcomes of patients with type 2 diabetes mellitus and chronic kidney disease published in domestic and foreign databases were retrieved and collected. The time limit was from the establishment of each database to November 2025. After screening, the quality of the research literature was evaluated using the Cochrane library. Literature management was conducted using NoteExpress 3.2, and data collection and extraction were carried out using Excel 2003. Statistical analysis was performed using RevMan 5.4.1 software. Based on the size of the Q test (P value), it was determined whether there was heterogeneity in the studies, and then the fixed or random effect model was used to calculate the combined effect OR value, and a forest plot was drawn. Then, the publication bias was evaluated by drawing a funnel plot. Results: A total of 10 studies that met the inclusion criteria were finally included. The meta-analysis results showed that compared with the control group, the eGFR and CrCI levels of patients treated with 5 mg dapagliflozin showed a more significant decline, renal-related adverse events (OR = 0.91, 95% CI: 0.84 to 0.99, P = 0.04), and the occurrence of doubling of serum creatinine, end-stage renal disease, and renal death events (OR = 0.68, 95% CI: 0.60 to 0.78, P < 0.00001). However, there was no statistically significant difference in acute kidney injury or failure between the two groups. Sensitivity analysis suggested that the results of this study were stable and reliable. Conclusion: SGLT2 inhibitors can cause a short-term decline in eGFR and CrCl, and significantly reduce the risk of renal composite endpoint events. This indicates that their early hemodynamic effects are predictable physiological changes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261294499, identifier CRD420261294499.