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Meta-Analysis
. 2025 Jul 4;104(27):e43171.
doi: 10.1097/MD.0000000000043171.

Efficacy and outcomes of dapagliflozin in diabetic nephropathy: A systematic review and meta-analysis

Krishna Dahal  1 , Laba Rawal  1 , Sangam Shah  1 , Madhur Bhattarai  1 , Himal Bikram Bhattarai  2 , Aakash Acharya  3 , Sujata Bhandari  4 , Amita Paudel  5 , Sanjit Sah  6   7   8 , Rachana Mehta  9   10   11 , Ashwini Gupta  12
Affiliations
Meta-Analysis

Efficacy and outcomes of dapagliflozin in diabetic nephropathy: A systematic review and meta-analysis

Krishna Dahal et al. Medicine (Baltimore). .

Abstract

Background: Diabetic nephropathy is one of the most prevalent consequences of diabetes and is associated with increased morbidity and mortality in diabetic patients. The pathogenesis of Diabetic Nephropathy is very complex and is still not fully understood, resulting in poor therapeutic outcomes. Dapagliflozin is thought to be associated with decreased progression of diabetic nephropathy. However, fewer trials have been conducted for the role of dapagliflozin in human patients with diabetic nephropathy. This is the first systematic review and meta-analysis where we aim to generate appropriate evidence regarding the safety and efficacy of dapagliflozin in diabetic nephropathy.

Methods: We searched the databases like PubMed, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase for studies published from inception to November 2023. Bias assessment was done using risk of bias tool for randomized controlled trial (RCT) and Newcastle-Ottawa scale for non-randomized studies. Synthesis of the data was done using RevMan 5.4 software. Efficacy was assessed in terms of lowering HbA1c level, serum creatinine, and urine albumin-to-creatinine ratio. Statistical heterogeneity was measured by using the I squared test and the results were reported using forest plots.

Results: Two studies were selected, 1 RCT and 1 comparative study including 296 patients. The dapagliflozin-treated group showed significant improvements in lowering serum creatinine [Standardized mean difference (SMD): -0.56 (-1.08, -0.04), P < .00001] and HbA1c [SMD: -0.84 (-1.07, -0.61), P = .03] when compared to the control group. But there was no discernible change in urine albumin-to-creatinine ratio [SMD: -1.45 (-3.33, 0.42), P = .13] after dapagliflozin therapy. Hypoglycemia [risk ratio: 0.26 (0.08-0.82), P = .02] was considerably lower in the dapagliflozin treatment group than in the control group in terms of safety.

Conclusion: This meta-analysis showed that dapagliflozin was more effective in treating diabetic nephropathy while having fewer side effects. Our results support to the endeavor of conducting bigger, multicentre RCTs that assess dapagliflozin's efficacy and delineate its unfavorable risk profile.

Keywords: SGLT2 inhibitor; cardiovascular outcomes; dapagliflozin; diabetic nephropathy; meta-analysis; renal outcomes.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
PRISMA flowchart. PRISMA = preferred reporting items for systematic reviews and meta-analyses.
Figure 2.
Figure 2.
Forest plot showing HbA1c level in the dapagliflozin treated group compared to controls.
Figure 3.
Figure 3.
Forest plot showing creatinine in the dapagliflozin treated group compared to controls.
Figure 4.
Figure 4.
Forest plot showing UACR in the dapagliflozin treated group compared to controls. UACR = urinary albumin-to-creatinine ratio.
Figure 5.
Figure 5.
Forest plot showing Hypoglycemia in the dapagliflozin treated group compared to controls.
See this image and copyright information in PMC

References

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