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The following is a summary of “Long-Term Effects of Empagliflozin in Patients with Chronic Kidney Disease,” published in the October 2024 issue of Nephrology by Herrington et al.
The EMPA-KIDNEY trial showed the cardiorenal benefits of the sodium–glucose cotransporter 2 (SGLT2) inhibitor empagliflozin in chronic kidney disease (CKD). Post-trial follow-up assessed its effects after discontinuation.
Researchers conducted a retrospective study on empagliflozin in patients with CKD. The study showed continued cardiorenal benefits up to 12 months after discontinuation.
They randomly assigned patients with CKD to receive either empagliflozin (10 mg once daily) or a placebo, with a median follow-up of 2 years. Patients had an eGFR between 20 and 45 ml/min/1.73 m2 or between 45 and 90 ml/min/1.73 m2 with a urinary albumin-to-creatinine ratio of at least 200. After the active trial, surviving patients who consented were observed for an additional 2 years without trial medication, but open-label SGLT2 inhibitors, including empagliflozin, could be prescribed. The primary outcome was kidney disease progression or cardiovascular death.
The results showed that of 6,609 randomized patients, 4,891 (74%) were enrolled in the post-trial period. Open-label SGLT2 inhibitor use was similar between groups (43% in the empagliflozin group, 40% in the placebo group). During the combined periods, 865 of 3,304 patients (26.2%) in the empagliflozin group and 1,001 of 3,305 patients (30.3%) in the placebo group had a primary-outcome event (hazard ratio (HR), 0.79; 95% CI, 0.72–0.87). In the post-trial period, the HR for a primary-outcome event was 0.87 (95% CI, 0.76–0.99). The risk of kidney disease progression was 23.5% in the empagliflozin group and 27.1% in the placebo group; the risk of death or end-stage kidney disease was 16.9% and 19.6%, respectively; and the risk of cardiovascular death was 3.8% and 4.9%, respectively. There was no effect on death from noncardiovascular causes (5.3% in both groups).
Investigators found that empagliflozin provided lasting cardiorenal benefits for up to 12 months after discontinuation in at-risk patients with CKD.
Source: nejm.org/doi/full/10.1056/NEJMoa2409183
