Meta-analysis finds SGLT2 inhibitors reduce cardiac arrest risk in CKD patients

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Frontiers in Medicine Published May 13, 2026 Medically reviewed May 13, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider SGLT2i for cardiac arrest risk reduction in CKD, but note no effect on ventricular arrhythmias or AV block.

This meta-analysis of 8 randomized controlled trials assessed the effect of SGLT2 inhibitors versus placebo on cardiac arrest, ventricular arrhythmia, and atrioventricular block in patients with chronic kidney disease. The analysis included data from 8 RCTs, though follow-up duration was not reported.

For cardiac arrest, SGLT2i significantly reduced risk (RR 0.53, 95% CI 0.29-0.95, P=0.03), with absolute event rates of 0.12% vs. 0.23%. However, no significant reductions were observed for ventricular arrhythmia (RR 0.72, 95% CI 0.34-1.55, P=0.40) or atrioventricular block (RR 0.77, 95% CI 0.42-1.40, P=0.38). Secondary outcomes including ventricular tachycardia, ventricular flutter/fibrillation, second-degree AVB, and third-degree AVB also showed no significant differences.

Limitations were not reported in the source, and safety data including adverse events and discontinuations were not provided. The certainty of evidence was not reported, and the findings are based on association rather than causation.

For clinical practice, SGLT2i may reduce cardiac arrest risk in CKD patients, but they did not demonstrate benefit for specific life-threatening arrhythmias. Clinicians should interpret these results with caution given the low event rates and lack of reported limitations.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundThe main cause of death for chronic kidney disease (CKD) is cardiac arrest caused by life-threatening arrhythmias, such as ventricular arrhythmia (VA) and atrioventricular block (AVB). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been proven to have a preventive effect on atrial arrhythmia. This meta-analysis aimed to evaluate whether SGLT2i could prevent life-threatening arrhythmias in CKD patients.MethodsWe searched PubMed, Embase, Cochrane Library, and Clinical Trials.gov until August 2025. Randomized controlled trials (RCTs) that compared the effect of SGLT2i and placebo on cardiac arrest, VA, and AVB in CKD patients were included. VA included ventricular tachycardia (VT), ventricular flutter (VFL), and ventricular fibrillation (VF). AVB only included second-degree and third-degree AVB. Risk ratio (RR) with 95% confidence interval (CI) was calculated using a random-effects model.Results8 RCTs were included. Among them, 7 RCTs reported cardiac arrest, 5 reported VA, and 5 reported AVB. SGLT2i could reduce the risk of cardiac arrest in CKD patients (0.12% vs. 0.23%; RR 0.53, 95% CI 0.29–0.95, P = 0.03), while didn't reduce the risk of VA (0.09% vs. 0.12%; RR 0.72, 95% CI 0.34–1.55, P = 0.40) and AVB (0.15% vs. 0.19%; RR 0.77, 95% CI 0.42–1.40, P = 0.38). Subgroup analyses revealed that SGLT2i did not prevent the incidents of VF/VFL (RR 0.42, 95% CI 0.13–1.34, P = 0.14), VT (RR 1.20, 95% CI 0.42–3.43, P = 0.74), second-degree (RR 2.03, 95% CI 0.65–6.33, P = 0.22) and third-degree (RR 0.51, 95% CI 0.24–1.08, P = 0.08) AVB.ConclusionSGLT2i could reduce the risk of cardiac arrest in CKD patients, but had no effect on specific types of life-threatening arrhythmias, such as VT, VF/VFL, second-degree and third-degree AVB.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261388417