Abstract: FR-OR46
Impact of Primary Kidney Disease on the Effects of Empagliflozin in Patients with CKD
Session Information
- Interventions to Reduce CKD Progression
November 03, 2023 | Location: Room 119, Pennsylvania Convention Center
Abstract Time: 05:15 PM - 05:24 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Judge, Parminder K., University of Oxford, Oxford, United Kingdom
- Herrington, William G., University of Oxford, Oxford, United Kingdom
Group or Team Name
- On Behalf of the EMPA-KIDNEY Collaborative Group.
Background
The EMPA-KIDNEY trial reported that empagliflozin reduced the risk of its primary composite outcome of kidney disease progression or cardiovascular death in a broad range of patients with CKD at risk of progression. We now compare effects on kidney outcomes among the different types of kidney diseases studied.
Methods
Eligible patients with eGFRs ≥20-45, or ≥45-90 ml/min/1.73m2 with a urinary albumin-to-creatinine ratio of ≥200 mg/g, and receiving renin angiotensin system inhibitor, where indicated and tolerated were randomised to empagliflozin 10mg once daily vs matching placebo. Kidney disease progression was defined as a sustained ≥40% eGFR decline from randomisation or to <10 mL/min/1.73m2, start of maintenance dialysis or receipt of a kidney transplant, or renal death, and the effects of empagliflozin were analysed using a pre-specified Cox model. Testing for heterogeneity of effect between pre-specified kidney disease subgroups was performed, including exploratory analyses by specific glomerular disease aetiologies.
Results
6609 participants were followed for a median of 2.0 years. 2057 (31%) had diabetic kidney disease, 1669 (25%) had glomerular disease, 1442 (22%) had hypertensive or renovascular disease, and 1441 (22%) had other or unknown causes. Overall, empagliflozin reduced the risk of kidney disease progression by 29% (empagliflozin 384/3304 vs placebo 504/3305; hazard ratio 0.71, 95%CI 0.62-0.81). This relative risk reduction appeared broadly similar in subgroup analyses by primary cause of kidney disease and by different types of glomerular disease, with limited data in participants with focal segmental glomerulosclerosis (Fig. 1).
Conclusion
EMPA-KIDNEY studied a large number of patients with diabetic and non-diabetic causes of CKD and showed that empagliflozin reduced risk of kidney disease progression with relative risk reductions that were broadly similar across the different CKD aetiologies.
Fig. 1: Effect of empagliflozin on kidney disease progression by cause of kidney disease
Funding
- Commercial Support – Boehringer Ingelheim & Eli Lilly (Clinicaltrials.gov: NCT03594110).