Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 81(19), 1902–1914. https://doi.org/10.1016/j.jacc.2023.03.390 Dr. Javed Butler et al.
Points
- Empagliflozin, an antidiabetic medication, was evaluated across different stages of chronic kidney disease (CKD) in a pooled analysis of two trials.
- Patients at higher risk of CKD experienced a slower decline in estimated glomerular filtration rate (eGFR) but had a higher risk of composite kidney events in the placebo group.
- Empagliflozin consistently reduced the risk of cardiovascular death or heart failure hospitalizations across all Kidney Disease Improving Global Outcomes (KDIGO) categories.
- The magnitude of the renal effects of empagliflozin varied depending on the method used to calculate eGFR slopes, with the most considerable effect observed using the chronic slope calculation.
- The study concludes that the benefits of empagliflozin on major heart failure events were not influenced by the stage of CKD, highlighting its potential to improve cardiovascular outcomes and slowing kidney function decline in patients with chronic heart failure and CKD.
Summary
This research paper presents a pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials, aiming to assess the impact of empagliflozin, an antidiabetic medication, across different stages of chronic kidney disease (CKD). The study involved 9,718 participants categorized into Kidney Disease Improving Global Outcomes (KDIGO) groups based on their estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio.
The results showed that patients at higher risk of CKD experienced a slower decline in eGFR but had a higher risk of composite kidney events in the placebo arm. However, empagliflozin demonstrated consistent efficacy in reducing the risk of cardiovascular death or heart failure hospitalizations across all KDIGO categories. The hazard ratios (HRs) for empagliflozin compared to placebo were 0.81 (95% CI: 0.66-1.01) for the low-risk group, 0.63 (95% CI: 0.52-0.76) for the moderate-risk group, 0.82 (95% CI: 0.68-0.98) for the high-risk group, and 0.84 (95% CI: 0.71-1.01) for the very-high-risk group. The reduction in the rate of eGFR decline was observed using different methods of slope calculation, with the most considerable effect seen in the chronic slope calculation.
In conclusion, the benefits of empagliflozin on major heart failure outcomes were consistent across all KDIGO categories, indicating that the stage of CKD did not influence the drug’s efficacy. The magnitude of the renal effects varied depending on the approach used to calculate eGFR slopes, with the chronic slope method demonstrating a larger effect. This study highlights the potential of empagliflozin in improving cardiovascular outcomes and slowing the decline of kidney function in patients with chronic heart failure and CKD.
Link to the article: https://www.jacc.org/doi/10.1016/j.jacc.2023.03.390
References Butler, J., Packer, M., Siddiqi, T. J., Böhm, M., Brueckmann, M., Januzzi, J. L., Verma, S., Gergei, I., Iwata, T., Wanner, C., Ferreira, J. P., Pocock, S. J., Filippatos, G., Anker, S. D., & Zannad, F. (2023). Efficacy of empagliflozin in patients with heart failure across kidney risk categories. Journal of the American College of Cardiology, 81(19), 1902–1914. https://doi.org/10.1016/j.jacc.2023.03.390
