Kidney Week

Abstract: PO2546

Effect of Empagliflozin on Kidney Biochemical and Imaging Outcomes in Patients with Type 2 Diabetes, or Prediabetes, and Heart Failure with Reduced Ejection Fraction (SUGAR-DM-HF)

Session Information

• Late-Breaking Clinical Trials Posters
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Lee, Matthew M.Y., University of Glasgow, Glasgow, Glasgow, United Kingdom

Matthew M.Y. Lee,

• Allwood-Spiers, Sarah, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, United Kingdom

Sarah Allwood-Spiers,

• Hall Barrientos, Pauline, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, United Kingdom

Pauline Hall Barrientos,

• Wetherall, Kirsty, University of Glasgow, Glasgow, Glasgow, United Kingdom

Kirsty Wetherall,

• Mcconnachie, Alex, University of Glasgow, Glasgow, Glasgow, United Kingdom

Alex Mcconnachie,

• Welsh, Paul, University of Glasgow, Glasgow, Glasgow, United Kingdom

Paul Welsh,

• Roditi, Giles, University of Glasgow, Glasgow, Glasgow, United Kingdom

Giles Roditi,

• Sourbron, Steven, The University of Sheffield, Sheffield, Sheffield, United Kingdom

Steven Sourbron,

• Radjenovic, Aleksandra, University of Glasgow, Glasgow, Glasgow, United Kingdom

Aleksandra Radjenovic,

• McMurray, John, University of Glasgow, Glasgow, Glasgow, United Kingdom

John McMurray,

• Jhund, Pardeep, University of Glasgow, Glasgow, Glasgow, United Kingdom

Pardeep Jhund,

• Petrie, Mark C., University of Glasgow, Glasgow, Glasgow, United Kingdom

Mark C. Petrie,

• Sattar, Naveed, University of Glasgow, Glasgow, Glasgow, United Kingdom

Naveed Sattar,

• Mark, Patrick B., University of Glasgow, Glasgow, Glasgow, United Kingdom

Patrick B. Mark,

Group or Team Name

• SUGAR-DM-HF Investigators

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of worsening kidney function in patients with diabetes, and heart failure with reduced ejection fraction (HFrEF). We explored the mechanisms underlying this benefit using magnetic resonance imaging (MRI).

Methods

We designed a multicenter randomized, double-blind, placebo-controlled trial to investigate the renal effects of empagliflozin in patients with left ventricular ejection fraction (LVEF) ≤40% and type 2 diabetes or prediabetes. Patients were randomized 1:1 to empagliflozin 10 mg once daily or placebo. Pre-specified exploratory outcomes included change from baseline to 36 weeks in kidney MRI biomarkers: kidney blood flow measured by a) arterial spin labelling (pCASL) and b) magnetic resonance renography (MRR), T1, apparent extracellular volume (aECV), volume.

Results

We randomized 105 patients: mean age 68.7 [SD 11.1] years, 77 (73%) male, 82 (78%) diabetes, mean eGFR 67 [22] mL/min/1.73m², mean urinary albumin:creatinine (uACR) 73 [277] mg/g. Compared with placebo, empagliflozin reduced right whole kidney (WK) and right cortex (Cx) pCASL by 27 (95% CI, -49 to -5; P=0.017) and 27 (-51 to -4; P=0.024) mL/100mL/min respectively, reduced right WK aECV by 4.2 (-7.8 to -0.7; P=0.02) %, and reduced urinary sodium concentration by 15 (-26 to -4; P=0.009) mmol/L. Similar results were seen for left WK pCASL, left Cx pCASL and left WK aECV. There were no between-group differences in MRR, kidney T1, total kidney volume, eGFR, uACR or fractional sodium excretion.

Conclusion

Empagliflozin reduced kidney blood flow measured by pCASL, but not by MRR, in patients with HFrEF and type 2 diabetes or prediabetes. Reduction in kidney blood flow may be a mechanism by which SGLT2 inhibitors reduce the risk of worsening kidney function in HFrEF.

Funding

• Commercial Support – Boehringer Ingelheim