Empagliflozin and Major Renal Outcomes in Heart Failure

This pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials evaluated the renal effects of empagliflozin in patients with heart failure. The primary outcome was a composite of major adverse renal events (profound/sustained eGFR decline or renal-replacement therapy). Among 9718 patients, empagliflozin significantly reduced renal outcomes in the EMPEROR-Reduced trial (HR 0.51; 95% CI, 0.33–0.79) but not in EMPEROR-Preserved (HR 0.95; 95% CI, 0.73–1.24), with heterogeneity between trials (P=0.016). Empagliflozin also slowed eGFR decline post-discontinuation, particularly in reduced ejection fraction. These findings suggest ejection fraction influences renal benefits, challenging eGFR slope as a surrogate for hard renal outcomes.

This pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials evaluated the renal effects of empagliflozin in patients with heart failure. The primary outcome was a composite of major adverse renal events (profound/sustained eGFR decline or renal-replacement therapy). Among 9718 patients, empagliflozin significantly reduced renal outcomes in the EMPEROR-Reduced trial (HR 0.51; 95% CI, 0.33–0.79) but not in EMPEROR-Preserved (HR 0.95; 95% CI, 0.73–1.24), with heterogeneity between trials (P=0.016). Empagliflozin also slowed eGFR decline post-discontinuation, particularly in reduced ejection fraction. These findings suggest ejection fraction influences renal benefits, challenging eGFR slope as a surrogate for hard renal outcomes.