SESSION 2
Favorable Kidney Outcomes Are Associated with Empagliflozin vs. DPP4i in Patients with Diabetes and Normal Kidney Function Real-World Evidence
Kidney-protective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) are supported by both randomized control trials and real-world evidence in high cardiorenal risk type 2 diabetes mellitus (T2DM) patients. However, patient populations in these trials had relatively high kidney and/ or cardiovascular risk compared to the general T2D population. Long-term efficacy studies in T2DM patients with normal kidney function and low cardiorenal risk are lacking.1-4
The long-term kidney outcomes were assessed among patients with T2D initiated on empagliflozin or any SGLT2i (empagliflozin and dapagliflozin), compared with those initiated on dipeptidyl peptidase-4 inhibitors (DPP4i) using MHS (2015-2021), a large Israeli database. The study focused on T2D patients with low baseline KDIGO risk (eGFR≥60 ml/min/1.73 m2, UACR<30 mg/g) and no cardiovascular history. The primary outcome included a composite of ≥40% sustained eGFR decline, end-stage kidney disease (ESKD), or all-cause death.4
Empagliflozin confers long-term benefits in kidney disease prevention among patients with type 2 diabetes and low KDIGO risk
5195 empagliflozin or DPP4i initiators (mean age of 60 years, mean eGFR of 93 mL/min/1.73 m2) were followed for a median of 35.2 months.4
In patients with T2D and low KDIGO risk at baseline, compared to DPP-4i, empagliflozin was associated with a lower risk for composite of ≥40% sustained eGFR decline, ESKD, or all-cause death (HR 0.80 (95% CI 0.65, 0.97; p=0.026)).4
The attenuation of eGFR decline observed with empagliflozin compared to DPP-4i appeared to continue with longer follow-up.4
This study supports the long-term benefits of empagliflozin in kidney disease prevention even among T2D patients with low renal risk.4
Figure 1: Empagliflozin vs DPP4i Kidney or Death Outcome: ≥40% sustained eGFR, end-stage kidney disease, or all-cause death.4
References
1. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446.
2. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-2128.
3. Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med. 2016;375(4):323-334.
4. Schechter M, Cohen CM, Aliza Rozenberg A, et al. 867-P: Favorable Kidney Outcomes Are Associated with Empagliflozin vs. DPP4i in Patients with Diabetes and Normal Kidney Function Real-World Evidence. Poster presentation at: American Diabetes Association 82nd Scientific Sessions; June, 2022.
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