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ASN kidney week 2022

Kidney benefits of SLGT2 inhibitors: evidence from clinical trials

Nature Reviews Nephrology volume 19, page 3 (2023)Cite this article

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New findings presented at the ‘High-Impact Clinical Trials’ session of ASN Kidney Week 2022 provided further evidence that sodium–glucose co-transporter 2 (SGLT2) inhibitors are renoprotective across different categories of kidney disease severity and aetiology, as well as diabetes status.

William Herrington presented results from the EMPA-KIDNEY clinical trial, which focused on patients with chronic kidney disease (CKD) at risk of disease progression owing to low estimated glomerular filtration rate (eGFR) or albuminuria. Specifically, participants either had an eGFR of 20–45 ml/min/1.73 m2, or an eGFR of <90 ml/min/1.73 m2 and a urinary albumin-to-creatinine ratio (UACR) of ≥200 mg/g. In this randomized double-blind trial, 6,609 patients were randomly assigned to receive either 10 mg of empagliflozin or placebo. Fifty-four per cent of patients in each group did not have diabetes. Over a median follow-up of 2 years, empagliflozin significantly reduced the risk of the primary outcome — progression of kidney disease or death from cardiovascular causes — compared with placebo (event rate 13.1% versus 16.9%; HR 0.72, P < 0.001). The annual rate of eGFR decline also improved with empagliflozin compared with placebo, achieving a difference of 1.37 ml/min/1.73 m2 between the groups; this difference in eGFR slope was most pronounced in patients with a UACR of >300 mg/g. Prespecified subgroup analyses suggested these benefits applied to patients with CKD, with or without diabetes, and across different CKD severity categories based on eGFR or albuminuria. Beyond the kidney outcomes, the trial also showed that patients treated with empagliflozin had lower rates of hospitalization from any cause than patients receiving placebo.

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References

Original articles

  • The EMPA-KIDNEY Collaborative Group. Empagliflozin in patients with chronic kidney disease. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa2204233 (2022)

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  • The Nuffield Department of Population Health Renal Studies Group & the SGLT2 inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet 400, 1788–1801 (2022)

    Article  Google Scholar 

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  1. Nature Reviews Nephrology http://www.nature.com/nrneph

    Monica Wang

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  1. Monica Wang
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Correspondence to Monica Wang.

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Wang, M. Kidney benefits of SLGT2 inhibitors: evidence from clinical trials. Nat Rev Nephrol 19, 3 (2023). https://doi.org/10.1038/s41581-022-00659-9

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