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Abstract: FR-OR52

EMPEROR-Reduced: Empagliflozin and Outcomes in Heart Failure and CKD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Author

  • Zannad, Faiez, Univesrite de Lorraine, Nancy, France

Group or Team Name

  • The EMPEROR Reduced trial steering committe and investigators
Background

In EMPEROR-Reduced, empagliflozin reduced cardiovascular death and heart failure hospitalizations and slowed the progressive decline in kidney function in heart failure and a reduced ejection fraction (HFrEF), with or without diabetes. We explored the effect of empagliflozin on cardiovascular and kidney outcomes, across the spectrum of kidney function.

Methods

3730 patients were randomized, of whom 1978 (53%) had prevalent chronic kidney disease (CKD) (eGFR<60ml/min/1.73m2 or an UACR>300mg/g). The key outcomes were (1) a composite of cardiovascular death or hospitalization for heart failure; (2) total hospitalizations for heart failure, and (3) eGFR slope; the last was supported by a prespecified composite renal outcome (defined as a profound sustained decline in eGFR, chronic dialysis or transplant). The median follow-up was 16 months.

Results

Patients with prevalent CKD had a higher rate of CV and kidney events. Empagliflozin reduced the risk of cardiovascular death and hospitalization for heart failure by 25% (P< 0.001), reduced total hospitalizations for heart failure by 30% (P<0.001) and reduced the composite of chronic dialysis, transplant and renal death by 50% (P<0.01). All three benefits were seen consistently in patients with and without CKD (figure) and were apparent even in patients with severe impairment (eGFR from 20 to 30ml/min/1.73m2). Empagliflozin significantly slowed the yearly loss of eGFR and was well tolerated regardless of the level of baseline kidney function.

Conclusion

In patients with HFrEF, empagliflozin reduced serious heart failure and serious adverse kidney outcomes, and slowed the decline in kidney function, regardless of the presence or absence of CKD and across a broad spectrum of baseline kidney function.