European Primary Care Cardiovascular Society

Reduced worsening of kidney disease or CV death by SGLT2 inhibitor in CKD

News - Nov. 7, 2022

EMPA-KIDNEY – Empagliflozin and Cardiovascular Outcomes in Patients with Chronic Kidney Disease: The EMPA-KIDNEY Trial

Presented at the AHA Scientific Sessions 2022 by: David Preiss, PhD - Oxford, UK

Introduction and methods

Use of SGLT2 inhibitors reduces important clinical events in high-risk patients. Benefits occur regardless of presence of CVD or diabetes in these high-risk patients. The CV benefits of treatment with SGLT2 inhibitors in patients with chronic kidney disease may be similar to benefits in other high-risk populations. This was studied in the EMPA-KIDNEY trial.

EMPA-KIDNEY was a RCT of 6609 patients with chronic kidney disease who were randomized to the SGLT2 inhibitor empagliflozin or placebo. The effect of treatment on CVD, progression of kidney disease, and the need for hospitalization in patients with chronic kidney disease was investigated. Mean follow-up was 2.0 years.

In addition, a meta-analysis of 13 major trials of SGLT2i therapies involving 90,000 patients was performed. The effect of treatment on CVD and other outcomes was examined in 3 groups of high-risk patients: participants with T2DM with or at high risk of CVD (4 trials), heart failure (5 trials) or chronic kidney disease (4 trials).

Main results

EMPA-KIDNEY trial results

Meta-analysis results

Conclusion

The EMPA-KIDNEY trial in patients with chronic kidney disease showed that treatment with empagliflozin reduced the progression of kidney disease or CV death and reduced the need for all-cause hospitalization. Similar benefit for treatment with empagliflozin was seen regardless of CVD status. There were relatively few CV events, but results for CV death or HF hospitalization were consistent with findings from other trials

The meta-analysis of 13 major SGLT2i trials showed that in patients with diabetes reductions in CV death, and CV death and HF hospitalizations with use of SGLT2i were observed in all groups of high-risk patients. In patients without diabetes, use of SGLT2i also showed reduction in CV death, and in CV death and HF hospitalizations in patients with HF, but with less information in patients with chronic kidney disease.

The findings of the EMPA-KIDNEY trial were simultaneously published in The New England Journal of Medicine. Watch a video by David Preiss

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