Empagliflozin in Patients with Chronic Kidney Disease

This randomized, double-blind, placebo-controlled trial (EMPA-KIDNEY) evaluated empagliflozin in 6609 patients with chronic kidney disease (CKD) at risk for progression. Participants had an estimated GFR of 20–45 ml/min/1.73 m² (regardless of albuminuria) or 45–90 ml/min/1.73 m² with albumin-to-creatinine ratio ≥200 mg/g. Over a median follow-up of 2 years, empagliflozin reduced the risk of kidney disease progression or death from cardiovascular causes by 28% compared to placebo (HR 0.72; P<0.001). Benefits were consistent across key subgroups including non-diabetics and patients with low eGFR or albuminuria. Empagliflozin also reduced overall hospitalization rates (HR 0.86; P=0.003). Safety outcomes were broadly similar between groups; serious adverse events were rare and distributed evenly. The study demonstrates empagliflozin's efficacy across a broad CKD population, expanding therapeutic relevance beyond diabetic kidney disease.

This randomized, double-blind, placebo-controlled trial (EMPA-KIDNEY) evaluated empagliflozin in 6609 patients with chronic kidney disease (CKD) at risk for progression. Participants had an estimated GFR of 20–45 ml/min/1.73 m² (regardless of albuminuria) or 45–90 ml/min/1.73 m² with albumin-to-creatinine ratio ≥200 mg/g. Over a median follow-up of 2 years, empagliflozin reduced the risk of kidney disease progression or death from cardiovascular causes by 28% compared to placebo (HR 0.72; P<0.001). Benefits were consistent across key subgroups including non-diabetics and patients with low eGFR or albuminuria. Empagliflozin also reduced overall hospitalization rates (HR 0.86; P=0.003). Safety outcomes were broadly similar between groups; serious adverse events were rare and distributed evenly. The study demonstrates empagliflozin's efficacy across a broad CKD population, expanding therapeutic relevance beyond diabetic kidney disease.