Long-Term Effects of Empagliflozin in Patients with Chronic Kidney Disease

The EMPA-KIDNEY trial previously demonstrated positive cardiorenal effects of empagliflozin, an SGLT2 inhibitor, in patients with chronic kidney disease (CKD). This study assessed whether these benefits persisted after discontinuation of treatment.

During the active trial, 6609 patients received either empagliflozin (10 mg once daily) or placebo for a median of two years. The post-trial follow-up, enrolling 4891 patients, continued for two additional years, with open-label SGLT2 inhibitor use similar in both groups (43% in empagliflozin vs. 40% in placebo).

The primary composite outcome (kidney disease progression or cardiovascular death) occurred in 26.2% of empagliflozin patients vs. 30.3% of placebo patients (hazard ratio, 0.79; 95% CI, 0.72–0.87). Post-trial benefits persisted, though attenuated (hazard ratio, 0.87; 95% CI, 0.76–0.99). Kidney disease progression rates remained lower in the empagliflozin group (23.5%) vs. placebo (27.1%), confirming a lasting impact on renal function even after treatment cessation.

Cardiovascular deaths were 3.8% in the empagliflozin group vs. 4.9% in placebo (hazard ratio, 0.75; 95% CI, 0.59–0.95), suggesting a carryover effect in protecting cardiovascular health. Empagliflozin did not affect noncardiovascular mortality (5.3% in both groups).

The EMPA-KIDNEY trial previously demonstrated positive cardiorenal effects of empagliflozin, an SGLT2 inhibitor, in patients with chronic kidney disease (CKD). This study assessed whether these benefits persisted after discontinuation of treatment.

During the active trial, 6609 patients received either empagliflozin (10 mg once daily) or placebo for a median of two years. The post-trial follow-up, enrolling 4891 patients, continued for two additional years, with open-label SGLT2 inhibitor use similar in both groups (43% in empagliflozin vs. 40% in placebo).

The primary composite outcome (kidney disease progression or cardiovascular death) occurred in 26.2% of empagliflozin patients vs. 30.3% of placebo patients (hazard ratio, 0.79; 95% CI, 0.72–0.87). Post-trial benefits persisted, though attenuated (hazard ratio, 0.87; 95% CI, 0.76–0.99). Kidney disease progression rates remained lower in the empagliflozin group (23.5%) vs. placebo (27.1%), confirming a lasting impact on renal function even after treatment cessation.

Cardiovascular deaths were 3.8% in the empagliflozin group vs. 4.9% in placebo (hazard ratio, 0.75; 95% CI, 0.59–0.95), suggesting a carryover effect in protecting cardiovascular health. Empagliflozin did not affect noncardiovascular mortality (5.3% in both groups).