Empagliflozin Reduces Disease Progression, Mortality for CKD
Empagliflozin use in individuals with chronic kidney disease (CKD) is superior to placebo in reducing the risk of progression to kidney disease and mortality from cardiovascular causes, according to the results of the Study of Heart and Kidney Protection with Empagliflozin (EMPA-KIDNEY) clinical trial.
Included were 6609 patients with chronic kidney disease who were randomized to receive empagliflozin 10 mg (n = 3304) or matching placebo once daily (n = 3305). To be included, all participants must have had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml/min per 1.73 m2 of body-surface area or an eGFR of at least 45 but less than 90 ml/min per 1.73 m2 with a urinary albumin-to-creatine ratio of at least 200.
Progression to kidney disease was defined here as end-stage kidney disease, a sustained decrease in eGFR to less than 10 ml/min per 1.73 m2, a sustained decrease in eGFR of 40% or greater from baseline, or death from renal causes.
The results indicated that disease progression or death occurred in 13.1% (n = 432) of the empagliflozin group and 16.9% (n = 558) of the placebo group during the median follow-up of 2 years (HR 0.72 = 95% CI, 0.64 – 0.82; p < .001). These results were consistent despite diabetes status and across subgroups of eGFR ranges.
In addition, the rate of hospitalization from any cause was lower in the empagliflozin group (HR 0.86 = 95% CI, 0.78 – 0.95; p = .003). However, there was no significant differences in the groups in the composite outcome of hospitalization for heart failure or cardiovascular causes, death from any cause, and rates of serious adverse events. Hospitalization for heart failure or death from cardiovascular causes and death from any cause occurred in 4.0% and 4.5% of the empagliflozin group and 4.6% and 5.1% of the placebo group, respectively.
This study was funded by Boehringer Ingelheim and others.
“Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo,” concluded the authors.
Herrington WG, Staplin N, Wanner C, et al; the EMPA-KIDNEY collaborative group. Empagliflozin in patients with chronic kidney disease. NEJM. Published online November 4, 2022. https://www.nejm.org/doi/full/10.1056/NEJMoa2204233?query=TOC&cid=NEJM+eToc%2C+November+10%2C+2022+DM1648980_NEJM_Non_Subscriber&bid=1256342245