SGLT2 inhibitors significantly increased plasma renin activity levels in type 2 diabetes patients, particularly during short-term use, while plasma aldosterone concentration remained unchanged.
Meta-Analysis (n=380)
Does SGLT2i use affect plasma aldosterone concentration and plasma renin activity in adult patients with type 2 diabetes mellitus?
SGLT2 inhibitors transiently increase plasma renin activity during short-term use (≤3 months) in patients with type 2 diabetes, which may cause falsely low aldosterone-to-renin ratios during primary aldosteronism screening.
Effect estimate: SMD 0.40 (95% CI 0.06, 0.74)
The effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on plasma aldosterone concentration (PAC) and plasma renin activity (PRA) levels are still inconclusive. This meta-analysis aimed to demonstrate the changes in PAC and PRA levels after the use of SGLT2i in type 2 diabetes patients. A search for relevant publications was performed using PubMed/Medline, Scopus, Cochrane, and Embase databases from their inception through May 2022. Inclusion criteria were studies that contained data on crude PAC and PRA levels before and after the use of SGLT2i in adult type 2 diabetes patients. Standardized mean difference (SMD) with a 95% confidence interval (95% CI) was calculated. Data was separately analyzed by study design: randomized controlled study (RCT) and non-randomized controlled study (non-RCT). Ten studies involving 380 patients were included with two RCT and eight non-RCT. Serum PAC levels showed no significant change after the use of SGLT2i in both RCT and non-RCT. Significantly higher PRA levels were observed after the use of SGLT2i in both RCT and non-RCT with SMD of 0.40 ng/mL/hr; 95% CI (0.06, 0.74) and SMD of 0.36 ng/mL/hr; 95%CI (0.17, 0.55), respectively. Subgroup analysis found significantly higher PRA levels after the use of SGLT2i (SMD 0.45 ng/mL/hr; 95% CI (0.18, 0.71)) only in subgroups that used for three months or less. The use of SGLT2i in diabetes mellitus type 2 patients can affect PRA levels, especially during short-term use. PRA levels should be interpreted with caution in this population.
Manosroi et al. (Tue,) conducted a meta-analysis in Type 2 Diabetes Mellitus (n=380). SGLT2 inhibitors vs. Baseline (before SGLT2i use) was evaluated on Change in plasma renin activity (PRA) in randomized controlled trials (SMD 0.40, 95% CI 0.06, 0.74). SGLT2 inhibitors significantly increased plasma renin activity levels in type 2 diabetes patients, particularly during short-term use, while plasma aldosterone concentration remained unchanged.