Clinical efficacy of SGLT2 inhibitors in chronic heart failure and chronic kidney disease: a systematic review and meta-analysis

Introduction: Chronic heart failure (CHF) and chronic kidney disease (CKD) pose a significant medical burden, contributing to increased mortality and hospitalization rates. Sodium-glucose cotransporter 2 (SGLT2) inhibitors were initially developed for the treatment of type 2 diabetes mellitus; however, recent studies have demonstrated their cardiorenal protective effects. This systematic review aims to evaluate the impact of empagliflozin on CKD progression in patients with CHF across different ejection fractions. Methods: A systematic literature search was conducted in PubMed, Web of Science, ScienceDirect, and Google Scholar for studies published between 2010 and 2024. The analysis included randomized controlled trials comparing empagliflozin with placebo in patients with both CHF and CKD. The primary outcomes assessed were cardiovascular mortality, hospitalization rates, and CKD progression. Results: A meta-analysis of 14 studies (n = 27,792) revealed a significant reduction in cardiovascular mortality (OR = 0.76, 95% CI: 0.70–0.82), hospitalization rates (OR = 0.74, 95% CI: 0.70–0.79), and CKD progression (OR = 0.80, 95% CI: 0.74–0.87). Conclusions: Empagliflozin exhibits significant cardiorenal protective effects, independent of diabetes status. Its use is warranted to mitigate cardiovascular and renal risks in patients with CHF and CKD. Further research is needed to investigate its long-term effects. This systematic review is registered in the open-access registry PROSPERO (2025, CRD420250652303).