The preventive effect of sodium-glucose co-transporter-2 inhibitors on life-threatening arrhythmias in patients with chronic kidney disease: a meta-analysis.

BACKGROUND

The main cause of death for chronic kidney disease (CKD) is cardiac arrest caused by life-threatening arrhythmias, such as ventricular arrhythmia (VA) and atrioventricular block (AVB). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been proven to have a preventive effect on atrial arrhythmia. This meta-analysis aimed to evaluate whether SGLT2i could prevent life-threatening arrhythmias in CKD patients.

METHODS

We searched PubMed, Embase, Cochrane Library, and Clinical Trials.gov until August 2025. Randomized controlled trials (RCTs) that compared the effect of SGLT2i and placebo on cardiac arrest, VA, and AVB in CKD patients were included. VA included ventricular tachycardia (VT), ventricular flutter (VFL), and ventricular fibrillation (VF). AVB only included second-degree and third-degree AVB. Risk ratio (RR) with 95% confidence interval (CI) was calculated using a random-effects model.

RESULTS

8 RCTs were included. Among them, 7 RCTs reported cardiac arrest, 5 reported VA, and 5 reported AVB. SGLT2i could reduce the risk of cardiac arrest in CKD patients (0.12% vs. 0.23%; RR 0.53, 95% CI 0.29-0.95, P = 0.03), while didn't reduce the risk of VA (0.09% vs. 0.12%; RR 0.72, 95% CI 0.34-1.55, P = 0.40) and AVB (0.15% vs. 0.19%; RR 0.77, 95% CI 0.42-1.40, P = 0.38). Subgroup analyses revealed that SGLT2i did not prevent the incidents of VF/VFL (RR 0.42, 95% CI 0.13-1.34, P = 0.14), VT (RR 1.20, 95% CI 0.42-3.43, P = 0.74), second-degree (RR 2.03, 95% CI 0.65-6.33, P = 0.22) and third-degree (RR 0.51, 95% CI 0.24-1.08, P = 0.08) AVB.

CONCLUSION

SGLT2i could reduce the risk of cardiac arrest in CKD patients, but had no effect on specific types of life-threatening arrhythmias, such as VT, VF/VFL, second-degree and third-degree AVB.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261388417.