BMJ《SGLT-2抑制剂用于成人慢性肾脏病患者临床实践指南》解读

doi:10.12114/j.issn.1007-9572.2026.0006

中国全科医学 ›› 2026, Vol. 29 ›› Issue (22): 3079-3085.DOI: 10.12114/j.issn.1007-9572.2026.0006

BMJ《SGLT-2抑制剂用于成人慢性肾脏病患者临床实践指南》解读

瞿芙容¹, 赵黎君¹, 曾筱茜², 李静³^,^*(), 李舍予³^,⁴^,^*()

1．610041　四川省成都市，四川大学华西医院全科医学科
2．610041　四川省成都市，四川大学华西医院肾内科
3．610041　四川省成都市，四川大学华西医院内分泌代谢科
4．610041　四川省成都市，四川大学华西医院循证医学中心循证评价与快速指南研究室　中国Cochrane中心　中国MAGIC中心

收稿日期:2026-01-10 修回日期:2026-03-13 出版日期:2026-08-05 发布日期:2026-07-08
通讯作者: 李静, 李舍予
作者贡献：
瞿芙容负责论文起草、撰写；赵黎君、曾筱茜、李静给予建议；李舍予提出研究思路；李静、李舍予对文章进行修订，确定最终版本，对文章整体负责。
基金资助:
癌症、心脑血管、呼吸和代谢性疾病防治研究国家科技重大专项(2024ZD0532000，2024ZD0532003)

Interpretation of BMJ Clinical Practice Guideline: SGLT-2 Inhibitors for Adults with Chronic Kidney Disease

QU Furong¹, ZHAO Lijun¹, ZENG Xiaoxi², LI Jing³^,^*(), LI Sheyu³^,⁴^,^*()

1. Department of General Practice, West China Hospital, Sichuan University, Chengdu 610041, China
2. Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, China
3. Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
4. Department of Guideline and Rapid Recommendation, Center for Evidence-Based Medicine, West China Hospital, Sichuan University/China Cochrane Center/China MAGIC Center, Chengdu 610041, China

Received:2026-01-10 Revised:2026-03-13 Published:2026-08-05 Online:2026-07-08
Contact: LI Jing, LI Sheyu

摘要/Abstract

摘要： 2024年10月在BMJ期刊发布的《SGLT-2抑制剂用于成人慢性肾脏疾病患者临床实践指南》基于估算肾小球滤过率（eGFR）与蛋白尿水平对慢性肾脏疾病（CKD）患者的并发症和进展风险进行分层，将其划分为低危、中危、高危和极高危4个层级。指南对不同风险层级患者使用钠-葡萄糖共转运蛋白2（SGLT-2）抑制剂的获益与风险进行了量化评估，提出了分层推荐策略，例如，对于CKD进展及并发症风险较低或中等的成年患者，可以考虑使用SGLT-2抑制剂（弱推荐）；而对于风险较高或极高的成年患者，则推荐使用SGLT-2抑制剂（强推荐）。为患者的个体化决策提供了依据，有助于全科医生在不同临床场景中合理规范使用SGLT-2抑制剂。此外，指南快速推荐的网页版提供了高度可视化的证据和推荐呈现工具，便于全科医生快速查询，并支持医患共同决策的实施。

关键词: 钠-葡萄糖共转运蛋白2抑制剂, 慢性肾脏疾病, 风险分级, 诊疗指南, 医患共同决策

Abstract:

The clinical practice guideline on the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors in adult patients with chronic kidney disease (CKD), published in the BMJ in October 2024, stratifies patients with CKD into four risk tiers-low, moderate, high, and very high-based on estimated glomerular filtration rate (eGFR) and proteinuria levels to assess their risk of complications and disease progression. The guideline provides a quantitative evaluation of the benefits and risks of SGLT-2 inhibitors across different risk tiers and proposes a tiered recommendation strategy. For instance, for adult patients with CKD who have a low or moderate risk of disease progression and complications, the use of SGLT-2 inhibitors can be considered (weak recommendation); whereas for those with a high or very high risk, the use of SGLT-2 inhibitors is recommended (strong recommendation). This approach supports individualized decision-making for patients and assists general practitioners in the rational and standardized use of SGLT-2 inhibitors across diverse clinical settings. Additionally, the guideline's rapid-access web version offers highly visualized evidence and recommendation presentation tools, facilitating quick reference for general practitioners and supporting the implementation of shared decision-making between clinicians and patients.

Key words: Sodium-glucose transporter 2 inhibitors, Chronic kidney disease, Risk stratification, Diagnostic and treatment guideline, Physician-patient shared decision-making

中图分类号:

R 692

瞿芙容,赵黎君,曾筱茜,等. BMJ《SGLT-2抑制剂用于成人慢性肾脏病患者临床实践指南》解读[J]. 中国全科医学, 2026, 29(22): 3079-3085. DOI: 10.12114/j.issn.1007-9572.2026.0006.
QU Furong,ZHAO Lijun,ZENG Xiaoxi, et al. Interpretation of BMJ Clinical Practice Guideline: SGLT-2 Inhibitors for Adults with Chronic Kidney Disease[J]. Chinese General Practice, 2026, 29(22): 3079-3085. DOI: 10.12114/j.issn.1007-9572.2026.0006.

图/表 1

参考文献 34

[1]	Wang L M, Xu X, Zhang M, et al. Prevalence of chronic kidney disease in China: results from the sixth China chronic disease and risk factor surveillance[J]. JAMA Intern Med, 2023, 183(4): 298-310.
[2]	Luyckx V A, Al-Aly Z, Bello A K, et al. Sustainable Development Goals relevant to kidney health: an update on progress[J]. Nat Rev Nephrol, 2021, 17(1): 15-32. DOI: 10.1038/s41581-020-00363-6.
[3]	Kovesdy C P. Epidemiology of chronic kidney disease: an update 2022[J]. Kidney Int Suppl, 2022, 12(1): 7-11.
[4]	Stevens P E, Ahmed S B, Carrero J J, et al. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney Int, 2024, 105(4): S117-S314. DOI: 10.1016/j.kint.2023.10.018.
[5]	Rossing P, Caramori M L, Chan J C N, et al. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease[J]. Kidney Int, 2022, 102(5): S1-S127. DOI: 10.1016/j.kint.2022.06.008.
[6]	Ojha U, Reyes L, Eyenga F, et al. Diabetes, heart failure and beyond: elucidating the cardioprotective mechanisms of sodium glucose cotransporter 2 (SGLT2) inhibitors[J]. Am J Cardiovasc Drugs, 2022, 22(1): 35-46. DOI: 10.1007/s40256-021-00486-6.
[7]	Zou X Y, Shi Q Y, Vandvik P O, et al. Sodium-glucose cotransporter-2 inhibitors in patients with heart failure: a systematic review and meta-analysis[J]. Ann Intern Med, 2022, 175(6): 851-861. DOI: 10.7326/M21-4284.
[8]	Mcguire D K, Shih W J, Cosentino F, et al. Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: a meta-analysis[J]. JAMA Cardiol, 2021, 6(2): 148-158. DOI: 10.1001/jamacardio.2020.4511.
[9]	Nong K L, Jeppesen B T, Shi Q Y, et al. Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis[J]. BMJ, 2025, 390: e083039.
[10]	Herrington W G, Staplin N, Wanner C, et al. Empagliflozin in patients with chronic kidney disease [J]. N Engl J Med，2023, 388: 117-127. DOI: 10.1056/NEJMoa2204233.
[11]	Zou X Y, Shi Q Y, Li S Y. Time-varying effects of sodium-glucose cotransporter-2 inhibitors in patients with heart failure: an updated meta-analysis[J]. J Evid Based Med, 2024, 17(1): 13-16.
[12]	Zou X Y, He X C, Shi Q Y, et al. Time-varying cost-effectiveness analysis of sodium-glucose cotransporter-2 inhibitors in Chinese patients with heart failure and reduced ejection fraction: a microsimulation of the real-world population[J]. Front Pharmacol, 2025, 16: 1527972. DOI: 10.3389/fphar.2025.1527972.
[13]	Agarwal A, Zeng X X, Li S Y, et al. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline[J]. BMJ, 2024, 387: e080257.
[14]	Zou X Y, Shi Q Y, Olav Vandvik P, et al. Sodium-glucose co-transporter-2 inhibitors in patients with chronic kidney disease with or without type 2 diabetes: systematic review and meta-analysis[J]. BMJ Medicine, 2024, 3(1): e001009.
[15]	李胜含, 杜和越, 安康, 等. 心血管疾病一级和二级预防患者用药习惯的价值观与偏好:一项探索式混合方法研究[J]. 中国全科医学, 2024, 27(27): 3336-3343. DOI: 10.12114/j.issn.1007-9572.2024.0056.
[16]	Carbone S, Dixon D L. The CANVAS Program: implications of canagliflozin on reducing cardiovascular risk in patients with type 2 diabetes mellitus[J]. Cardiovasc Diabetol, 2019, 18(1): 64. DOI: 10.1186/s12933-019-0869-2.
[17]	Liu J L, Li L, Li S Y, et al. Sodium-glucose co-transporter-2 inhibitors and the risk of diabetic ketoacidosis in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials[J]. Diabetes Obes Metab, 2020, 22(9): 1619-1627. DOI: 10.1111/dom.14075.
[18]	邹昕雨, 卜乐, 曲伸, 等. 成人肥胖的膳食干预:低碳水化合物饮食与低脂饮食[J]. 中华糖尿病杂志, 2025, 17(4): 444-449. DOI: 10.3760/cma.j.cn115791-20241204-00706.
[19]	Jardine M J, Zhou Z E, Mahaffey K W, et al. Renal, cardiovascular, and safety outcomes of canagliflozin by baseline kidney function: a secondary analysis of the CREDENCE randomized trial[J]. J Am Soc Nephrol, 2020, 31(5): 1128-1139. DOI: 10.1681/ASN.2019111168.
[20]	Wen L Y. Management of SGLT2i-associated perioperative ketoacidosis (SAPKA)/euglycemic diabetic ketoacidosis (EDKA)[J]. J Clin Anesth, 2025, 105: 111854. DOI: 10.1016/j.jclinane.2025.111854.
[21]	Singh M, Kumar A. Risks associated with SGLT2 inhibitors: an overview[J]. Curr Drug Saf, 2018, 13(2): 84-91.
[22]	Tuttle K R, Agarwal R, Alpers C E, et al. Molecular mechanisms and therapeutic targets for diabetic kidney disease[J]. Kidney Int, 2022, 102(2): 248-260. DOI: 10.1016/j.kint.2022.05.012.
[23]	孙林, 李莉. "肾三联": 2型糖尿病合并慢性肾脏病的治疗策略[J]. 中华医学杂志, 2025, 105(12): 867-871.
[24]	Mullens W, Martens P, Testani J M, et al. Renal effects of guideline-directed medical therapies in heart failure: a consensus document from the Heart Failure Association of the European Society of Cardiology[J]. Eur J Heart Fail, 2022, 24(4): 603-619.
[25]	Agarwal R, Green J B, Heerspink H J L, et al. Finerenone with empagliflozin in chronic kidney disease and type 2 diabetes[J]. N Engl J Med, 2025, 393(6): 533-543. DOI: 10.1056/nejmoa2410659.
[26]	Leon S J, Whitlock R, Rigatto C, et al. Hyperkalemia-related discontinuation of renin-angiotensin-aldosterone system inhibitors and clinical outcomes in CKD: a population-based cohort study[J]. Am J Kidney Dis, 2022, 80(2): 164-173.e1.
[27]	Luo X L, Xu J, Zhou S L, et al. Influence of SGLT2i and RAASi and their combination on risk of hyperkalemia in DKD: a network meta-analysis[J]. Clin J Am Soc Nephrol, 2023, 18(8): 1019-1030.
[28]	《钠-葡萄糖转运体抑制剂在慢性肾脏病患者临床应用的中国专家共识（年版）》专家组. 钠-葡萄糖转运体2抑制剂在慢性肾脏病患者临床应用的中国专家共识(2023年版)[J]. 中华糖尿病杂志, 2023, 15(12): 1213-1224.
[29]	Ueda P, Svanström H, Melbye M, et al. Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events: nationwide register based cohort study[J]. BMJ, 2018, 363: k4365.
[30]	Lupsa B C, Inzucchi S E. Use of SGLT2 inhibitors in type 2 diabetes: weighing the risks and benefits[J]. Diabetologia, 2018, 61(10): 2118-2125. DOI: 10.1007/s00125-018-4663-6.
[31]	Neal B, Perkovic V, Mahaffey K W, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes[J]. N Engl J Med, 2017, 377(7): 644-657. DOI: 10.1056/nejmoa1611925.
[32]	中华医学会糖尿病学分会糖尿病与肥胖学组, 中国高血压联盟, 祝之明, 等. 成人2型糖尿病的高血压管理中国专家共识[J]. 中国循证医学杂志, 2025, 25(6): 621-632.
[33]	Ibrahim M, Ba-Essa E M, Ahmed A, et al. Recommendations for the management of diabetes during Ramadan applying the principles of the ADA/EASD consensus: update 2025[J]. Diabetes Metab Res Rev, 2025, 41(5): e70057. DOI: 10.1002/dmrr.70057.
[34]	Yuan Z, Defalco F J, Ryan P B, et al. Risk of lower extremity amputations in people with type 2 diabetes mellitus treated with sodium-glucose co-transporter-2 inhibitors in the USA: a retrospective cohort study[J]. Diabetes Obes Metab, 2018, 20(3): 582-589. DOI: 10.1111/dom.13115.

BMJ《SGLT-2抑制剂用于成人慢性肾脏病患者临床实践指南》解读

Interpretation of BMJ Clinical Practice Guideline: SGLT-2 Inhibitors for Adults with Chronic Kidney Disease

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