Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial
Secondary analysis of RCT (n=6609) found empagliflozin caused a modest initial drop in kidney function (2.12 mL/min per 1.73 m2 reduction in eGFR first 2 months) followed by a substantial slowing of rate of progression of chronic kidney disease among all types of eGFR stages.
Source:
The Lancet Diabetes & Endocrinology
Resource links:
Additional secondary analysis study
SPS commentary:
An additional analysis of the EMPA-kidney trial assessed how effects of empagliflozin might differ by primary kidney disease across its broad population. It found empagliflozin reduced the risk of kidney disease progression in patients with chronic kidney disease, including diabetic kidney disease, glomerular disease, and hypertensive or renovascular disease. Authors conclude that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.
A related commentary discusses the findings of this secondary analysis and suggests that it may advance knowledge on the categories of patients that benefit from the effect of empagliflozin on the kidney. It discusses the first analysis on patients with low albuminuria which found empagliflozin mitigated the progression of CKD including in those with albuminuria, and highlights the authors conclusion that using albuminuria to identify patients who should be treated with SGLT2 inhibitors is unjustified. It discusses the second study and suggests that the causes of primary kidney disease are irrelevant to the decision to prescribe empagliflozin to prevent CKD.