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

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical


  • Mayer, Gert J., Medical University Innsbruck, Innsbruck, Austria
  • Wanner, Christoph, Würzburg Univ Clinic, Würzburg, Germany
  • Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Inzucchi, Silvio E., Yale University School of Medicine, New Haven, Connecticut, United States
  • Koitka-Weber, Audrey, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
  • Hantel, Stefan, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
  • von Eynatten, Maximilian, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
  • Zinman, Bernard, Lunenfeld-Tanenbaum Research Inst, Mount Sinai Hospital, Toronto, Ontario, Canada
  • Cherney, David, Toronto General Hospital, Univ of Toronto, Toronto, Ontario, Canada

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.


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.


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%).


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.


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