Empagliflozin, a sodium glucose cotransporter-2 inhibitor, improved clinical outcomes and reduced mortality in patients with type 2 diabetes (T2D), cardiovascular disease and chronic kidney disease (CKD), according to a study published Sept. 13 in Circulation.

Christoph Wanner, MD, et al., sought to gain additional insights from the EMPA-REG OUTCOME trial on the impact of empagliflozin in patients with CKD at baseline. Patients with T2D, established cardiovascular disease and an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 were randomized to receive empagliflozin 10 mg, empagliflozin 25 mg or placebo once daily in addition to standard of care. Cardiovascular death, hospitalization for heart failure, all-cause hospitalization and all-cause mortality in patients with CKD were analyzed. Subgroups by baseline eGFR and baseline urine albumin-creatinine ratio (UACR) were also analyzed.

Results showed that 2,250 patients out of 7,020 had CKD at baseline, of whom 67 percent had a diagnosis of T2D for a duration more than 10 years; 58 percent were receiving insulin and 84 percent were taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers.

In patients with CKD at baseline, empagliflozin reduced the risk of cardiovascular death by 29 percent compared with placebo (hazard ratio [HR], 0.71; 95 percent confidence interval [CI], 0.52-0.98), all-cause mortality by 24 percent (HR, 0.76; 95 percent CI, 0.59-0.99), hospitalization for heart failure by 39 percent (HR, 0.61; 95 percent CI, 0.42-0.87) and all-cause hospitalization by 19 percent (HR, 0.81; 95 percent CI, 0.72-0.92).

The risk reductions were consistent between patients with and without CKD. Effects of empagliflozin on cardiovascular death, all-cause mortality, hospitalization for heart failure and all-cause hospitalization were also consistent across categories of eGFR and of UACR at baseline and across the two doses studied. The adverse event profile of empagliflozin was similar across subgroups by renal function at baseline.

The study authors write, "Our findings add to evidence showing that empagliflozin significantly slowed the progression of kidney diseases and reduced clinically relevant renal events in the overall population of the EMPA-REG OUTCOME trial."

Keywords: Angiotensin-Converting Enzyme Inhibitors, Diabetes Mellitus, Type 2, Angiotensin Receptor Antagonists, Insulin, Creatinine, Confidence Intervals, Glomerular Filtration Rate, Standard of Care, Glucosides, Benzhydryl Compounds, Renal Insufficiency, Chronic, Heart Failure, Hospitalization, Risk Reduction Behavior, Sodium-Glucose Transport Proteins, Albumins

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