Empagliflozin Improves Kidney Outcomes Irrespective of Control of Blood Pressure, Low-Density Lipoprotein Cholesterol and HbA1c

C Wanner; M Cooper; S Inzucchi; B Zinman; I Zwiener; M von Eynatten; A Koitka-Weber

doi:10.1055/s-0039-1688342

Diabetologie und Stoffwechsel, Table of Contents

Diabetologie und Stoffwechsel 2019; 14(S 01): S80
DOI: 10.1055/s-0039-1688342

Poster

Diabetes und Niere

Georg Thieme Verlag KG Stuttgart · New York

Empagliflozin Improves Kidney Outcomes Irrespective of Control of Blood Pressure, Low-Density Lipoprotein Cholesterol and HbA1c

Authors

C Wanner

¹Würzburg University Clinic, Department of Medicine, Würzburg, Germany
M Cooper

²Monash University, Department of Diabetes, Melbourne, Victoria, Australia
S Inzucchi

³Yale University, School of Medicine, New Haven, United States
B Zinman

⁴University of Toronto, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
I Zwiener

⁵Boehringer Ingelheim International GmbH, Boehringer Ingelheim International GmbH, Ingelheim, Germany
M von Eynatten

⁵Boehringer Ingelheim International GmbH, Boehringer Ingelheim International GmbH, Ingelheim, Germany
A Koitka-Weber

⁵Boehringer Ingelheim International GmbH, Boehringer Ingelheim International GmbH, Ingelheim, Germany

Abstract

Full Text

Aims:

The EMPA-REG OUTCOME trial demonstrated the renoprotective role of the sodium-glucose co-transporter 2 inhibitor empagliflozin by reducing the risk of incident or worsening nephropathy by 39% vs. placebo in patients with type 2 diabetes and established cardiovascular (CV) disease. We investigated the effects of controlling the CV risk factors of blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and glycated haemoglobin (HbA1c) on treatment differences in kidney outcomes.

Methods:

In EMPA-REG OUTCOME patients were randomised to empagliflozin 10 mg or 25 mg, or placebo. Risk of incident or worsening nephropathy was assessed in the pooled empagliflozin group vs. placebo adjusting for control of BP, LDL-C and HbA1c at baseline and during the study as time-dependent covariates. Control of the various parameters was defined as systolic BP < 140 mmHg and diastolic BP < 90 mmHg, LDL-C< 100 mg/dL, and HbA1c< 7.5%.

Results:

Adjusting for control of BP, LDL-C or HbA1c individually, hazard ratios (HRs) (95% CI) for time to incident or worsening nephropathy with empagliflozin vs. placebo were 0.67 (0.59, 0.76), 0.61 (0.53, 0.69) and 0.65 (0.57, 0.74), respectively. This is consistent with findings in the overall trial population. Adjusting for control of all 3 parameters, the HR (95% CI) was 0.65 (0.57, 0.75).

Conclusion:

Empagliflozin reduced the risk of incident or worsening nephropathy to the same extent when analyses were adjusted for control of BP, LDL-C and HbA1c over time. These data suggest that risk reductions in kidney outcomes were preserved, irrespective of control of conventional CV risk factors.