Abstract: TH-PO1047
Effects of Empagliflozin on Serum Uric Acid and Gout in CKD
Session Information
- CKD: Therapeutic Advances
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Author
- Mayne, Kaitlin J., University of Oxford Nuffield Department of Population Health, Oxford, United Kingdom
Group or Team Name
- The EMPA-KIDNEY Collaborative Group.
Background
Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce serum uric acid and may reduce the risk of gout in patients with diabetes and/or heart failure, but randomized evidence in patients with CKD is lacking.
Methods
EMPA-KIDNEY compared empagliflozin 10 mg daily with placebo in 6609 patients with CKD (Clinicaltrials.gov: NCT03594110). Eligible patients had an eGFR of 20 to <45; or 45 to <90 mL/min/1.73m2 with ≥200 mg/g albuminuria. Serum uric acid measured at randomization, 2 and 18 months was analyzed using a mixed model repeated measures approach including interaction terms to estimate subgroup-specific effects with calculation of heterogeneity or trend statistics. In exploratory analyses, first and total gout events were analyzed in Cox regression models with the Andersen-Gill extension for total events. All models were adjusted for age, sex, region, eGFR, uACR and diabetes status.
Results
Mean±SD baseline serum uric acid was 431.3±113.5 µmol/L. Empagliflozin reduced serum uric acid (study average between-group difference [95% CI] -25.6 [-30.3, -21.0] µmol/L). Uric acid lowering was greater in participants without diabetes (heterogeneity P<0.001) and at higher eGFR (trend P<0.001; Figure). During 2 years’ median follow-up, there was no significant effect of empagliflozin on risk of gout events alone (whether analyzing first or all occurrences, Table) which was consistent across subgroups including by baseline diabetes, eGFR and uric acid concentration (heterogeneity P all >0.1).
Conclusion
In EMPA-KIDNEY, empagliflozin modestly reduced serum uric acid with greater effects at higher eGFR and in those without diabetes, but did not significantly reduce episodes of gout.
Effects of empagliflozin versus placebo on gout
| Empagliflozin n/N | Empagliflozin Rate per 1000 patient-years | Placebo n/N | Placebo Rate per 1000 patient-years | Hazard Ratio (95% CI) | |
| First occurrence of gout | 278/3304 | 45.7 | 317/3305 | 52.3 | 0.87 (0.74-1.02) |
| All occurrences of gout | 404/3304 | 62.2 | 465/3305 | 71.7 | 0.86 (0.72-1.03) |
| First occurrence of gout or new initiation of xanthine oxidase inhibitor, primary uricosuric agent or colchicine in participants not on such therapy at randomization | 261/2135 | 66.3 | 314/2124 | 81.8 | 0.81 (0.69-0.96) |
Effects of empagliflozin versus placebo on serum uric acid and gout in subgroups defined by baseline characteristics
Funding
- Commercial Support – EMPA-KIDNEY trial funding from Boehringer Ingelheim & Eli Lilly