Kidney Week

Abstract: SA-PO0437

Kidney Outcomes with Empagliflozin 10 mg vs. 25 mg: Subgroup Analyses in Patients with Diabetes, Heart Failure, and CKD

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Younis, Nour Khaled, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Nour Khaled Younis, MD

• Saade, Marie Christelle, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Marie Christelle Saade, MD

• Jin, Yujia, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Yujia Jin

• McAdams, Meredith C., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Meredith C. McAdams, MD

Background

EMPA-KIDNEY established the renoprotective benefit of empagliflozin. However, real-world data evaluating renal outcomes between 10 mg and 25 mg doses is limited.

Methods

We conducted a retrospective chart review of adults treated with empagliflozin 10 mg or 25 mg between January 1, 2020 and December 31, 2025 at The University of Texas Southwestern Medical Center. Demographics, comorbidities, medications, and laboratory values were compared between the groups. Longitudinal creatinine, eGFR, UACR, and hemoglobin A1c values were obtained from treatment initiation and evaluated using regression models with polynomial time terms and dose-by-time interactions. Stratified analyses were performed in patients with diabetes, heart failure, and CKD. Sensitivity analyses were done in those treated for ≥1 year.

Results

6937 individuals were included in the analyses. Compared to those prescribed 10 mg, patients prescribed empagliflozin 25 mg were younger and more likely to have diabetes, with higher baseline hemoglobin A1c, but had a more favorable kidney and cardiovascular profile. The 25 mg group had lower baseline creatinine (0.98 vs 1.17 mg/dL, p<0.001), higher eGFR (79.0 vs 67.8 mL/min/1.73 m², p<0.001), lower UACR (159 vs 234 mg/g, p=0.014), and lower prevalence of CKD (18.5% vs 32.4%, p<0.001), heart failure (16.6% vs 40.7%, p<0.001), and coronary artery disease (19.2% vs 30.0%, p<0.001). AKI was less frequent in the 25 mg group across follow-up windows, including within 12 months in the overall cohort (14.9% vs 25.9%, p<0.001) and among patients with ≥1 year of empagliflozin use (13.3% vs 22.3%, p<0.001). In subgroup analyses of patients with diabetes, heart failure, and CKD, significant dose-by-time interactions were observed for creatinine and hemoglobin A1c in selected models; however, these findings varied by subgroup and follow-up definition and did not consistently favor 25 mg. No consistent significant dose-by-time interactions were observed for eGFR or UACR in the various subgroups.

Conclusion

In this real-world cohort, empagliflozin 25 mg did not show consistent renal or glycemic benefit over 10 mg in individuals with diabetes, heart failure, and CKD compared to those without these conditions. Although AKI was observed less frequently with 25 mg, baseline differences suggest residual confounding may have influenced outcomes.

Acknowledgment

The authors acknowledge the UTSW Clinical Data Exchange Network (ClinDEN) for their support with cohort identification and data extraction.