Empagliflozin and Major Renal Outcomes in Heart Failure

This correspondence describes a pooled patient-level analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials, investigating the impact of empagliflozin on major adverse renal outcomes in patients with heart failure. Across 9718 participants, empagliflozin reduced the risk of serious renal outcomes (profound and sustained eGFR decline or need for renal-replacement therapy) in patients with reduced ejection fraction (HR 0.51; 95% CI, 0.33–0.79), but showed no significant benefit in those with preserved ejection fraction (HR 0.95; 95% CI, 0.73–1.24). The findings suggest that ejection fraction modifies empagliflozin’s renoprotective effect and that eGFR slope may be an unreliable surrogate for predicting renal endpoints in heart failure. Authors conclude that serious renal events are reduced only in heart failure with reduced ejection fraction.

This correspondence describes a pooled patient-level analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials, investigating the impact of empagliflozin on major adverse renal outcomes in patients with heart failure. Across 9718 participants, empagliflozin reduced the risk of serious renal outcomes (profound and sustained eGFR decline or need for renal-replacement therapy) in patients with reduced ejection fraction (HR 0.51; 95% CI, 0.33–0.79), but showed no significant benefit in those with preserved ejection fraction (HR 0.95; 95% CI, 0.73–1.24). The findings suggest that ejection fraction modifies empagliflozin’s renoprotective effect and that eGFR slope may be an unreliable surrogate for predicting renal endpoints in heart failure. Authors conclude that serious renal events are reduced only in heart failure with reduced ejection fraction.