ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO227

Short-Term Changes in Albuminuria and Risk of Cardiovascular Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the EMPA-REG OUTCOME Trial

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Xie, Di, University Medical Center Groningen, Groningen, Netherlands
  • Waijer, Simke W., University Medical Center Groningen, Groningen, Netherlands
  • von Eynatten, Maximilian, Boehringer Ingelheim International GmbH, Ingelheim, Germany
  • Koitka-Weber, Audrey, Boehringer Ingelheim International GmbH, Ingelheim, Germany
  • Inzucchi, Silvio E., Yale University School of Medicine, New Haven, Connecticut, United States
  • Zinman, Bernard, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  • Wanner, Christoph, Wurzburg University Clinic, Wurzburg, Germany
  • L Heerspink, Hiddo Jan, University Medical Center Groningen, Groningen, Netherlands
Background

Previous studies, primarily with RAAS inhibitors, have demonstrated that a reduction in albuminuria (UACR) during the first months of treatment is associated with improved long-term cardiovascular (CV) outcomes. Whether an early reduction in UACR with SGLT2 inhibition is also a positive indicator of long-term CV benefit is unknown. We therefore assessed the association between changes in UACR over the first 12 weeks of treatment with empagliflozin or placebo and subsequent long-term CV risk in a post-hoc analysis from the EMPA-REG OUTCOME trial.

Methods

We calculated UACR change as the percentage difference from baseline to week 12 in 6820 participants who did not experience a CV outcome during the first 12 weeks. Cox regression models were used to estimate the hazard ratio (HR) for the primary MACE outcome (non-fatal MI, non-fatal stroke, CV death) and CV death or hospitalization for heart failure (CVD/HHF) for each 30% reduction in UACR after adjustment for treatment assignment, laboratory measurements and medication use.

Results

Empagliflozin compared to placebo reduced UACR by 18% (95%CI 14-22%), and increased the likelihood of a ≥30% reduction in UACR at week 12 compared to placebo (odds ratio 1.42 [95%CI 1.27-1.58]). Over a median follow-up of 3.0 years, 704 (10.3%) primary CV and 440 (6.5%) CVD/HHF outcomes were observed. Each 30% reduction in UACR during the first 12 weeks was independently associated with an average 5% lower hazard for the MACE outcome (HR 0.95; 95%CI 0.91–0.98, p=0.002), and 8% lower hazard for the CVD/HHF outcome (HR 0.92; 95%CI 0.88–0.96, p<0.001). Results were consistent in subgroups by baseline characteristics or medication use, or empagliflozin/placebo treatment assignment(Figure).

Conclusion

Short-term reduction in UACR was more common with empagliflozin and was independently associated with a decreased risk of long-term CV outcomes. These results suggest that a change in albuminuria is a prognostic marker for CV outcomes.

Funding

  • Commercial Support