Empagliflozin in Patients with Chronic Kidney Disease

The EMPA-KIDNEY trial aimed to investigate the effects of empagliflozin in patients with chronic kidney disease (CKD) at risk of disease progression. The study enrolled individuals with an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m2 or an eGFR of at least 45 but less than 90 ml per minute per 1.73 m2 with a urinary albumin-to-creatinine ratio of at least 200. Participants were randomly assigned to receive empagliflozin (10 mg once daily) or a placebo. The primary outcome was a composite of kidney disease progression or death from cardiovascular causes.

A total of 6609 patients underwent randomization, and during a median follow-up of 2.0 years, 13.1% of patients in the empagliflozin group experienced kidney disease progression or death from cardiovascular causes, compared to 16.9% in the placebo group (hazard ratio 0.72; 95% CI, 0.64 to 0.82; P<0.001). This risk reduction was consistent across patient subgroups, including those with or without diabetes and various eGFR ranges. Additionally, the empagliflozin group showed a lower rate of hospitalization from any cause (hazard ratio 0.86; 95% CI, 0.78 to 0.95; P=0.003). However, there were no significant differences between groups in the composite outcome of hospitalization for heart failure or death from cardiovascular causes (4.0% in the empagliflozin group vs. 4.6% in the placebo group) or death from any cause (4.5% vs. 5.1%, respectively). The rates of serious adverse events were similar in both groups.

In conclusion, among a diverse group of patients with chronic kidney disease at risk for progression, empagliflozin therapy demonstrated a significant reduction in the risk of kidney disease progression or death from cardiovascular causes compared to placebo. The study also indicated a lower rate of hospitalization from any cause with empagliflozin. These findings contribute valuable insights into the potential benefits of empagliflozin in managing chronic kidney disease in a broad population, supporting its role as a therapeutic option in this context.

https://www.nejm.org/doi/full/10.1056/NEJMoa2204233