Effect of SGLT2i on shifts in KDIGO CKD risk groups in T2DM patients

EASD 2022 A post-hoc analysis of EMPA-REG OUTCOME examined the effect of empagliflozin on changes in risk of progression to ESKD by assessing worsening and improvement in KDIGO risk groups.

Presented at the EASD annual meeting 2022 by: Prof. Silvio Inzucchi, MD- New Haven, CT, USA

Introduction and methods

A large meta-analysis of 5 SGLT2i trials (EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, CREDENCE and VERTIS CV) by McGuire et al. showed that treatment with an SGLT2i resulted in reduced risk of time to first renal composite outcome (HR 0.62, 95%CI:0.56-0.70) with a consistent effect in the five trials. Subsequently, dedicated SGLT2i randomized trials have been performed in CKD populations: CREDENCE, DAPA-CKD and EMPA-KIDNEY.

The KDIGO heat map has 18 categories of kidney function based on eGFR and urine albumin creatinine ratio (UACR). These categories are ordered in 4 groups: low, moderate, high and very high risk for progression to end stage kidney disease (ESKD). The heat map is clinically used to identify patients with or at risk for CVD and to encourage prompt subspeciality referral as needed.

The aim of this study was to examine the effect of empagliflozin on changes in risk of progression to ESKD by assessing worsening and improvement in KDIGO risk groups in the EMPA-REG OUTCOME trial.

Data of 7020 patients with T2DM and established CVD in the EMPA-REG OUTCOME was used. In this trial, patients were randomized to empagliflozin or placebo and followed for a median of 3.1 years. For this analysis, patients were categorized based on their KDIGO CKD risk group at baseline and at their last value on-treatment.

Main results

• Worsening in KDIGO CDK risk category occurred less across all baseline groups in patients on empagliflozin compared to those on placebo (OR 0.70, 95%CI:0.62-0.78).
• Improvement in KDIGO CKD risk group occurred more often across all baseline groups in patients on empagliflozin compared with the placebo group (OR 1.56, 95%CI:1.30-1.86).

Conclusion

In this analysis of EMPA-REG OUTCOME, use of empagliflozin in patients with T2DM and established CVD was associated with a 30% lower risk of worsening in KDIGO CKD risk groups and a >50% higher risk of improvement in KDIGO CKD risk group compared with placebo.

These data support greater use of SGLT2 inhibitors across a broad spectrum of CDK risk, concluded Prof. Inzucchi.

- Our reporting is based on the information provided at the EASD annual meeting -