Evidence before this study
CKD, kidney disease, chronic kidney
disease, acute kidney injury, albuminuria
CARDIOVASCULAR MORBIDITY
Meta-analysis of the large randomized trials of SGLT2 inhibitors shows that they
reduce the risk of kidney disease progression in patients with chronic kidney
disease (CKD), as well as acute kidney injury and cardiovascular morbidity and
mortality. These analyses were limited by an inability to explore effects in
small subgroups or patients whose CKD was only progressing slowly. The
EMPA-KIDNEY trial recruited a broad range of patients with CKD, including
patients without significant albuminuria. There were relatively few clinical
kidney outcomes in this subgroup during 2 years of follow-up, and the results
suggested that the proportional benefit of allocation to empagliflozin might be
smaller at lower levels of albuminuria. This has led to some uncertainty about
the benefits of SGLT2 inhibition in such patients who constitute the majority of
CKD patients globally. The use of estimates of the annualised decline in kidney
function (“eGFR slopes”) has recently been proposed as an
alternative outcome for trials in CKD. It has advantages for exploring the
results of large randomized trials because all participants provide information
so such analyses are statistically sensitive.