#1267 Impact of diabetes, albuminuria, acute eGFR dip, and disease severity on the effects of empagliflozin on progression of chronic kidney disease
Abstract
Sodium glucose co-transporter-2 (SGLT2) inhibitors reduce risk of kidney outcomes in a range of populations at risk, but there is conflicting evidence on benefits at different levels of albuminuria and uncertainty about use when there are large acute dips in estimated glomerular filtration rate (eGFR) on initiation of therapy.
We performed a meta-analysis using individual participant level data from four large placebo-controlled empagliflozin trials (EMPA-REG OUTCOME, EMPEROR-Reduced, EMPEROR-Preserved, EMPA-KIDNEY). Baseline risk of an acute eGFR dip with empaglflozin was estimated using multivariable models. The categorical kidney disease progression was defined as a sustained ≥40% decrease in eGFR from randomisation, a sustained eGFR <10 ml/min/1.73 m2, receipt of long-term kidney replacement therapy, or death from kidney failure. Chronic eGFR slopes provided a sensitive method to compare effects on progression between subgroups. Cox models for the categorical outcome and shared parameter models for eGFR slope analyses were constructed for each trial and then combined using an inverse variance weighted assumption-free approach. Tests for heterogeneity or trend tests then assessed for effect modification by diabetes status, level of albuminuria, baseline risk of an acute eGFR dip, primary cause of kidney disease, and markers of disease severity.
Four trials involving a total of 23,340 participants were included (mean ± SD eGFR 59 ± 24 ml/min/1.73 m2; median [Q1–Q3] urinary…
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