Kidney Week

Abstract: FR-OR092

Are the Renal Effects of Empagliflozin Consistent in Patients Already Using Medications That Alter Renal Hemodynamics? An Exploratory Analysis from EMPA-REG OUTCOME

Session Information

• SGLT-2 Inhibitors and Diabetic Kidney Disease
  November 03, 2017 | Location: Room 282, Morial Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Diabetes

• 502 Diabetes Mellitus and Obesity: Clinical

Authors

• Mayer, Gert J., Medical University Innsbruck, Innsbruck, Austria

Gert J. Mayer, MD



https://www.i-med.ac.at/universitaet/senat/file/cv_gert_mayer_english.pdf

• Wanner, Christoph, Würzburg Univ Clinic, Würzburg, Germany

Christoph Wanner,

• Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States

Matthew R. Weir,

• Inzucchi, Silvio E., Yale University School of Medicine, New Haven, Connecticut, United States

Silvio E. Inzucchi,

• Koitka-Weber, Audrey, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany

Audrey Koitka-Weber,

• Hantel, Stefan, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany

Stefan Hantel,

• von Eynatten, Maximilian, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany

Maximilian von Eynatten,

• Zinman, Bernard, Lunenfeld-Tanenbaum Research Inst, Mount Sinai Hospital, Toronto, Ontario, Canada

Bernard Zinman,

• Cherney, David, Toronto General Hospital, Univ of Toronto, Toronto, Ontario, Canada

David Cherney,

Background

Among patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk, the SGLT2 inhibitor empagliflozin (EMPA) decreases progression of kidney disease, likely via reduction in intraglomerular pressure. These patients often receive other agents to prevent development or progression of both CV disease (CVD) and chronic kidney disease (CKD). Some of these agents may also alter renal hemodynamics, such as RAS inhibitors, diuretics, NSAIDs and CCBs. We investigated whether the renal effects of EMPA are consistent in those already using these background medications.

Methods

7020 patients with T2D and established CVD were randomized (1:1:1) to EMPA 10 mg, 25 mg or placebo (PBO) in addition to standard of care. Differences in risk of incident or worsening nephropathy for EMPA vs PBO across subgroups by baseline background medications were assessed using a Cox proportional hazards model. Acute renal failure (ARF) events were assessed based on the MedDRA narrow standardized query.

Results

Risk reductions in incident or worsening nephropathy seen with EMPA were consistent across background medication subgroups, with no heterogeneity of treatment effect (Figure). RAS inhibitors were the most commonly used background medication group and there was an overall increased risk for ARF with ACEi/ARBs in the PBO group (ACEi/ARB yes: 7% vs ACEi/ARB no: 5.2%) but no imbalance was seen with EMPA 10 mg and 25 mg, respectively (ACEi/ARB yes: 5.3% and 5.9%; ACEi/ARB no: 4.5%, 2.7%).

Conclusion

Addition of EMPA resulted in a consistent reduction in CKD progression in T2D patients at high CV risk, irrespective of commonly used background medications that also alter renal hemodynamics.

Funding

• Commercial Support –