Adverse Events of the Use of SGLT2 Inhibitors in Patients with Heart Failure: A Systematic Review and Meta-analysis

Background: Sodium-glucose cotransporter 2 (iSGLT2) inhibitors are a class of medications used in the treatment of Heart Failure (HF) to prevent the development and worsening of the disease. Despite the benefits reported in the literature, it is essential to investigate its adverse effects.

Objective: To evaluate the occurrence of hypotension, volume depletion and acute kidney injury in patients with HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction using iSGLT2.

Methodology: Systematic review and meta-analysis previously registered in PROSPERO (CRD42022365684) and carried out in the PubMed, EBSCO and LILACS databases. The risk of bias analysis was performed using the Cochrane risk-of-bias tool for randomized trials. RevMan 3.4.1 was used to perform the data meta-analysis.

Results: Of the 9,474 studies found, ten were included in the review. A risk of hypotension was observed in patients with HF using iSGLT2 (RR: 1.15; 95% CI 1.01 – 1.30; p=0.03; I2= 0%), but there was no risk statistically significant occurrence of volume depletion and acute kidney injury (RR: 1.12; 95% CI 1.95 – 1.33; p=0.17; I2= 0%; RR: 0.85; 95% CI 0 .69 – 1.06; p=0.14;

Conclusion: In therapy with iSGLT2, an increased risk of adverse events of hypotension was observed, but no increased risk of volume depletion and acute kidney injury was observed. Despite the 15% reduction in relative risk in the outcome of acute kidney injury, the results suggest a renal benefit.