# SGLT2-remmers verlagen hartfalen en nierprogressie — umbrella review

*geplaatst 2026-10-18 · Nierziekte · Journal of diabetes and metabolic disorders · doi 10.1007/s40200-026-02097-x · https://hartvaat.nl/2026/12/01/sglt2-remmers-verlagen-hartfalen-en-nierprogressie-umbrella-review/*

Deze umbrella review van 12 systematische reviews bevestigt de cardiorenale voordelen van SGLT2-remmers bij patiënten met hartfalen en chronische nierziekte, ook bij niet-diabetici. De analyse toont een reductie van cardiovasculaire sterfte of eerste hartfalen-opname (HR 0,77) en nierprogressie (RR 0,63), maar waarschuwt voor een verhoogd risico op genitale infecties (RR 3,30) en benadrukt dat het bewijs voor extra-cardiorenale effecten zoals levervet of jicht beperkt is. Voor de klinische praktijk bevestigt dit de reeds in richtlijnen verankerde rol van SGLT2-remmers, terwijl de lage methodologische kwaliteit van de onderliggende reviews een nuance vereist bij het interpreteren van bredere multisystem-effecten.

## English: Multisystem effects of sodium-glucose cotransporter-2 inhibitors beyond glycaemic control: an umbrella review of systematic reviews and meta-analyses.

This umbrella review synthesizes 12 systematic reviews to evaluate the multisystem effects of SGLT2 inhibitors beyond glucose control. It confirms robust cardiorenal benefits in heart failure and chronic kidney disease populations, including non-diabetics, with hazard ratios of 0.77 for cardiovascular death or first heart failure hospitalization and 0.91 for major adverse cardiovascular events. While genital infections are significantly more common (RR 3.30), evidence for benefits in liver fat or gout remains limited, and the overall certainty of evidence is critically low due to methodological limitations in the underlying reviews. Clinicians can rely on these findings to reinforce the established cardiorenal indication for SGLT2 inhibitors, while remaining cautious about extrapolating benefits to other organ systems.

## Abstract (original, from the publication)

PURPOSE: To map benefits and harms of sodium-glucose cotransporter-2 (SGLT2) inhibitors beyond glucose lowering and assess evidence certainty. METHODS: We searched PubMed/MEDLINE through 24 April 2026 and checked references. Two reviewers screened records and verified extracted data. Review methods were appraised with AMSTAR-2, and outcome certainty was judged using GRADE domains. Overlapping, non-interchangeable review estimates were not re-pooled. PROSPERO registration occurred after review initiation (CRD420261378845; 25 April 2026; retrospectively registered). RESULTS: Twelve PubMed-indexed reviews were included. Representative estimates showed fewer cardiovascular death or first heart-failure hospitalisation events (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.72-0.82), major adverse cardiovascular events (HR 0.91, 95% CI 0.87-0.96), and kidney disease progression (risk ratio [RR] 0.63, 95% CI 0.58-0.69). Liver fat decreased by 2.05% points (95% CI 1.48-2.61), but this was an imaging outcome, predominantly in type 2 diabetes. The RCT-only subgroup of a mixed-design gout review reported HR 0.74 (95% CI 0.55-0.98). Genital infection increased (RR 3.30, 95% CI 2.74-3.99); urinary tract infection and diabetic ketoacidosis estimates were imprecise or compatible with no difference. SGLT2 inhibition did not clearly reduce 28-day mortality in hospitalised COVID-19 (odds ratio 0.93, 95% CI 0.79-1.08). All reviews had critically low AMSTAR-2 confidence. CONCLUSION: Cardiorenal benefits are supported in the studied heart-failure and chronic-kidney-disease populations, including prespecified non-diabetic subgroups. Evidence for liver fat and gout is narrower and does not establish universal multisystem benefit. GRAPHICAL ABSTRACT: Outcome-specific summary of the strongest cardiorenal evidence, narrower extra-cardiorenal findings, and principal safety signal. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02097-x.

Auteurs: Naseem Eisa, Mira Khoury

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Bron: Journal of diabetes and metabolic disorders, https://doi.org/10.1007/s40200-026-02097-x. Bijgewerkt 2026-10-12T00:49:08Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.