[Renal Protection by SGLT2 Inhibitors in Patients with Heart Failure Depends on Ventricular Function: Pooled Analysis and -Analysis].

UNLABELLED: Heart failure (HF) and chronic kidney disease (CKD) often coexist, sharing common risk factors and pathophysiological mechanisms. Sodium-glucose cotransporter-2 inhibitors (iSGLT-2) have shown renal and cardiovascular benefits, but their renal protective effect varies depending on ejection fraction (EF).

AIM: To assess whether the renal protective effect of SGLT-2i depends on EF in HF patients.

METHODS

A meta-analysis was conducted with five randomized controlled trials comparing iSGLT-2 versus placebo in HF patients. Risk of bias was assessed using EPHPP. The primary outcome was major adverse kidney events (MAKE). Subgroups were defined by EF: HFrEF (≤40%) and HFpEF (>40%).

RESULTS

A total of 23,163 patients were included. Global analysis showed a non-significant trend towards a reduction in MAKE (RR 0.76 [0.56-1.02], I²= 68%). In HFrEF, iSGLT-2 significantly reduced MAKE (RR 0.58 [0.44-0.75], I²= 0%), whereas no benefit was observed in HFpEF (RR 1.01 [0.83-1.23], I²= 0%). Heterogeneity disappeared when stratified by EF.

CONCLUSIONS

iSGLT-2 reduce MAKE in HFrEF but not in HFpEF, suggesting that EF modulates their renal effect. These findings highlight the importance of tailoring cardiorenal syndrome management according to HF phenotype.