Kidney Week

Abstract: FR-PO981

Effects of Empagliflozin on Weight and Blood Pressure in CKD: Analyses from the EMPA-KIDNEY Trial

Session Information

• CKD Interventions: Trials and Quality Improvement
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Author

• Mayne, Kaitlin J., University of Oxford Nuffield Department of Population Health, Oxford, Oxfordshire, United Kingdom

Kaitlin J. Mayne,

Group or Team Name

• The EMPA-KIDNEY Collaborative Group.

Background

Sodium-glucose co-transporter-2 (SGLT2) inhibitors slow kidney disease progression and reduce cardiovascular risk in patients with CKD. SGLT2 inhibitors have additionally been shown to reduce weight and blood pressure (BP). We aimed to assess whether diabetes status or kidney function modify the effects of empagliflozin on weight and BP.

Methods

EMPA-KIDNEY compared empagliflozin 10 mg once daily with placebo among 6609 patients with CKD (Clinicaltrials.gov: NCT03594110). Eligible patients had an eGFR of 20 to <45; or 45 to <90 ml/min/1.73m² with a urinary albumin-to-creatinine ratio (uACR) ≥200 mg/g. Changes in weight and blood pressure from baseline were pre-specified analyses using mixed model repeated measures regression. Results were assessed overall and in important subgroups and put in the context of a bioimpedance substudy of 660 participants which is reported separately.

Results

At baseline, mean±SD eGFR was 37.3±14.5 mL/min/1.73m² with mean weight of 84.1±21.4 kg, and mean systolic and diastolic BP were 136.5±18.3 and 78.1±11.8 mmHg, respectively. The study-average between-group difference in weight was -0.9 (95% CI -1.2, -0.6) kg with similar-sized effects in all subgroups (Figure). Effects on weight persisted over time and bioimpedance analyses in a 660-participant substudy demonstrated that it reflected reductions in intracellular and extracellular water with no significant effect on adiposity. The study-average between-group differences (95% CI) in systolic and diastolic BP were -2.6 (-3.3, -1.9) and -0.5 (-0.9, -0.1) mmHg, respectively, with similar difference by baseline eGFR and uACR, but somewhat larger effects in patients with diabetes.

Conclusion

In a broad range of patients with CKD, empagliflozin reduces weight and BP, even at low eGFR, low uACR and in the absence of diabetes.

Funding

• Commercial Support – Boehringer Ingelheim & Eli Lilly