Empagliflozin May Reduce CKD Progression in Type 2 Diabetes

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The sodium–glucose cotransporter-2 inhibitor empagliflozin may help prevent progression of chronic kidney disease (CKD) in patients with type 2 diabetes, independently of background medications that alter intrarenal hemodynamics, reports a study in Kidney International.

The post hoc exploratory analysis used data from the industry-sponsored BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) trial.

In that earlier study, 7020 patients with type 2 diabetes and established cardiovascular disease were randomly assigned to empagliflozin 10 mg or 25 mg or placebo, added to standard care. On primary analysis, empagliflozin reduced major cardiovascular events,

The sodium–glucose cotransporter-2 inhibitor empagliflozin may help prevent progression of chronic kidney disease (CKD) in patients with type 2 diabetes, independently of background medications that alter intrarenal hemodynamics, reports a study in Kidney International.

The post hoc exploratory analysis used data from the industry-sponsored BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) trial.

In that earlier study, 7020 patients with type 2 diabetes and established cardiovascular disease were randomly assigned to empagliflozin 10 mg or 25 mg or placebo, added to standard care. On primary analysis, empagliflozin reduced major cardiovascular events, cardiovascular mortality, and hospitalization for heart failure.

The current study evaluated the effects of empagliflozin on the risk of incident or worsening nephropathy. The analysis included the impact of four classes of background medications known to affect intrarenal hemodynamics: angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEis/ARBs), calcium channel blockers, diuretics, and nonsteroidal anti-inflammatory drugs (NSAIDs). All patients in the study had a baseline estimated GFR of 30 mL/min per 1.73 m2 or higher.

Patients taking any of the classes of background medications tended to have higher rates of incident or worsening nephropathy. However, in all four subgroups of patients taking background medications known to affect intrarenal hemodynamics, the incidence of kidney events was lower with empagliflozin than with placebo. The protective effect of empagliflozin was consistent with that in the overall trial population, with no clinically relevant heterogeneity.

The use of empagliflozin in combination with other drugs did not increase the risk of serious adverse events or events leading to discontinuation.

The results suggest that the benefits of empagliflozin for patients with type 2 diabetes and established cardiovascular disease are consistent for patient subgroups taking widely used medications that affect intrarenal hemodynamics. The researchers conclude, “[O]ur data suggest that the proposed kidney mechanisms of empagliflozin (i.e., lowering of glomerular pressure) are preserved in patients already taking ACEis/ARBs, diuretics, calcium channel blockers, or NSAIDs.”

Mayer GJ, et al. Analysis from the EMPA-REG OUTCOME® trial indicates empagliflozin may assist in preventing the progression of chronic kidney disease in patients with type 2 diabetes irrespective of medications that alter intrarenal hemodynamics. Kidney Int 2019; 96:489–504.]

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