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Abstract: PO2544

Early Changes in Estimated Glomerular Filtration Rate Post-Initiation of Empagliflozin in EMPEROR Heart Failure Trials

Session Information

Category: Hypertension and CVD

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


  • Zannad, Faiez, Université de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France
  • Ferreira, João Pedro, CHRU Nancy - Hopitaux de Brabois, Nancy, France
  • Gregson, John, London School of Hygiene and Tropical, London, United Kingdom
  • Hauske, Sibylle Jenny, Boehringer Ingelheim, Ingelheim, Germany
  • Kraus, Bettina J., University Hospital, Wuerzburg, Germany
  • Mattheus, Michaela, Boehringer Ingelheim, Ingelheim, Germany
  • Butler, Javed, University of Mississippi School of Medicine, Jackson, Mississippi, United States
  • Filippatos, Gerasimos, Attikon University Hospital, Athens, Greece
  • Wanner, Christoph, University Hospital, Wuerzburg, Germany
  • Anker, Stefan D., Charité Medical School, Berlin, Germany
  • Pocock, Stuart, London School of Hygiene and Tropical, London, United Kingdom
  • Packer, Milton, Baylor Heart and Vascular Institute, Dallas, Texas, United States

Group or Team Name

  • EMPEROR-Preserved Trial Committees and Investigators

Sodium glucose co-transporter 2 inhibitors (SGLT2i) may induce a early post-initiation eGFR decrease which does not impact the SGLT2i benefits in patients with diabetes. The occurrence, characteristics, determinants, and clinical significance of eGFR change among patients with heart failure are yet to be described. We report here the results in EMPEROR-Reduced, with reduced ejection fraction (HFrEF). Results of EMPEROR-Preserved, in 5,988 patients with preserved ejection fraction (HFpEF), a trial which just terminated, will be reported at the ASN meeting. The aim is to describe eGFR change from baseline to week 4 (as % of change relative to baseline) and assess its impact in EMPEROR-Reduced.


Landmark analyses (week 4) were performed assessing the risk of outcomes across tertiles of eGFR change.


eGFR change was available in 3547 patients out of 3730 (95%). Empagliflozin induced a leftward distributional shift of early eGFR changes with more patients with an initial eGFR decline. In the empagliflozin group, applying multiple adjustment methods, the risk of cardiovascular and renal outcomes was not increased in patients in whom early post treatment initiation eGFR decreased as compared to patients in whom it increased or did not change. However, in the placebo group, patients in whom early post treatment initiation eGFR decreased had a higher risk of sustained worsening kidney function compared to patients in whom eGFR increased.


In EMPEROR-Reduced, modest post treatment initiation eGFR decrease was observed more frequently with empagliflozin than with placebo. Only in patients taking placebo eGFR decrease was associated with a higher risk of sustained worsening kidney function. Any post-empagliflozin initiation decrease in eGFR did not deprive patients from benefiting from empagliflozin therapy. Full results of these analyses in EMPEROR Reduced as well as results of similar analyses in EMPEROR-Preserved, with preserved ejection fraction (HFpEF) will be reported at the time of the meeting.


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