Kidney function decline slows in patients with diabetes on empagliflozin vs. placebo
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Key takeaways:
- Patients with type 2 diabetes on empagliflozin were significantly less likely to experience a rapid decline in eGFR compared to patients on placebo.
- The EMPA-REG OUTCOME trial included a 2.6-year follow-up.
Patients with type 2 diabetes and chronic kidney disease receiving empagliflozin were less likely to experience a decline in eGFR compared with patients taking placebo, results from a newly published study show.
“Type 2 diabetes (T2DM) is associated with an accelerated decline in kidney function and the development of chronic kidney disease (CKD), owing to diabetes itself and/or its comorbid conditions, such as hypertension, dyslipidemia, obesity, acute kidney injury (AKI), atherosclerosis and kidney ischemia, leading to an increased risk of kidney
Data derived from Hadjadj S, et al. Kid Med. 2023;doi:10.1016/j.xkme.2023.100783.
failure, major acute cardiovascular events, heart failure and premature mortality,” Samy Hadjadj, MD, Institut du thorax, Universite Nantes, CHU Nantes, Nantes, France, and international colleagues wrote. “The effect of CKD on patient health, quality of life, cost of care and ultimate prognosis in T2DM is profound.”
Among previous results from the EMPA-REG OUTCOME trial, researchers showed
empagliflozin, which helps patients with type 2 diabetes control blood sugar levels, reduced the risk of cardiovascular disease events and slowed the progression of kidney disease when compared with patients receiving placebo. In the current review of the study data, researchers randomly assigned patients who had T2DM, established cardiovascular disease and an eGFR of at least 30 mL/min/1.73 m2 to receive either empagliflozin (at a dose of 10 mg or 25 mg) or placebo daily in addition to standard care. The patient pool consisted of 6,967 participants and were followed for 2.6 years.
Results showed that eGFR declined in patients taking placebo at an average
of 1.8 mL/min/1.73 m2/year (95% CI, 2 to 1.6). In the group receiving empagliflozin, the eGFR declined at an average of 0.3 mL/min/1.73 m2/year (95% CI, 0.4 to 0.1). “The benefits of empagliflozin on the change in the eGFR were also observed at all categories of baseline albuminuria,” the authors wrote, “all levels of baseline eGFR and including by participants with and without prevalent CKD.”
Using a definition of rapid decline of eGFR of greater than 3 mL/min/1.73 m2 per year, 188 (9.5%) of patients on placebo experienced a rapid decline in kidney function compared with 134 (3.4%) patients treated with empagliflozin. When projecting eGFR decline during a 15-year follow-up, Hadjagj and colleagues estimated that 4.7% of the placebo-treated patients and 1.7% of the empagliflozin-treated patients would have end-stage kidney disease (defined as an eGFR of 10 mL/min/1.73 m2) and assuming the patient did not die.
“Distribution of individual annualized eGFR changes was shifted to the right in empagliflozin-treated patients, which would suggest a lower risk of rapid decline in the eGFR compared with placebo which, in turn, would lead to a reduced risk for projected kidney failure over an extrapolated period of 15 years of follow-up,” the authors wrote.
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