Across a wide range of patients with chronic kidney disease (CKD), treatment with empagliflozin reduces the risks of progressive CKD and death from cardiovascular causes, according to a clinical trial report in The New England Journal of Medicine (1).
In The Study of Heart and Kidney Protection with Empagliflozin (EMPA-KIDNEY), 6609 patients with CKD were randomly assigned to treatment with the sodium-glucose cotransporter-2 inhibitor empagliflozin at 10 mg/day or placebo. Eligible patients had an estimated glomerular filtration rate (eGFR) between 20 and 45 mL/min/1.73 m2 or an eGFR between 45 and 90 mL/min/1.73 m2 with a urinary albumin-to-creatinine ratio (UACR) of at least 200. Patients were “broadly representative” of patients with CKD with risk of disease progression. The mean age was 64 years, two-thirds were men, and 46% had diabetes.
At a median follow-up of 2 years, the groups were compared on a composite outcome of kidney disease progression, consisting of end stage kidney disease, sustained decrease in eGFR to less than 10 mL/min/1.73 m2, sustained decrease in eGFR of at least 40% from baseline, and death from renal causes, as well as death from cardiovascular causes.
Rates of progressive kidney diseases or cardiovascular death were 13.1% in patients assigned to empagliflozin versus 16.9% with placebo. The benefit was consistent across eGFR ranges and in patients with or without diabetes. After an initial acute decrease, the empagliflozin group had a slower rate of decline in eGFR, with a difference of 0.75 mL/min/1.73 m2 per year.
Empagliflozin was associated with a lower rate of all-cause hospitalization (hazard ratio, 0.86). Other secondary outcomes were similar between groups, including heart failure hospitalization, cardiovascular death, and all-cause mortality. Serious adverse events were similar between groups.
There are limited data on the benefits of empagliflozin for patients with CKD at risk of disease progression. The EMPA-KIDNEY results show that empagliflozin reduces CKD progression and cardiovascular death in a broad range of patients with CKD at risk for progressive disease. The researchers noted “consistent benefits” in patients with and without diabetes, those with an eGFR less than 30 mL/min/1.73 m2, and those with UACR under 300.
EMPA-KIDNEY Collaborative Group; Herrington WG, et al. Empagliflozin in patients with chronic kidney disease. N Engl J Med, published online ahead of print November 4, 2022. doi: 10.1056/NEJMoa2204233