Effects of empagliflozin on conventional and exploratory acute and chronic kidney outcomes: an individual participant-level meta-analysis

作者：William G. Herrington, Zhaojing J Che, Rebecca J. Sardell, Alistair Roddick, Parminder K. Judge, Christoph Wanner, Sibylle J. Hauske, Stefan D. Anker, Javed Butler, Gerasimos Filippatos, Milton Packer, Faiez Zannad, Dominik Steubl, Martina Brueckmann, Jennifer B. Green, Jonathan Emberson, Martin Landray, Colin Baigent, Richard Haynes, Natalie Staplin · 发表于：The Lancet Diabetes & Endocrinology · 年份：2025 · DOI：10.1016/s2213-8587(25)00222-0 · 被引用次数：12 · 研究领域：Diabetes Treatment and Management、Chronic Kidney Disease and Diabetes、Parathyroid Disorders and Treatments

BACKGROUND: Uncertainty remains about effects of sodium-glucose co-transporter-2 (SGLT2) inhibition on kidney outcomes in individuals with slowly progressive chronic kidney disease (eg, low albuminuria) and those at risk of large acute estimated glomerular filtration rate (eGFR) dips on initiation of such treatment. We aimed to explore the effects of empagliflozin on a range of kidney outcomes in these population subtypes. METHODS: In this meta-analysis, we used individual-level data from 23 340 participants in four large placebo-controlled trials (EMPA-REG OUTCOME, EMPEROR-Reduced, EMPEROR-Preserved, and EMPA-KIDNEY) to assess the effects of empagliflozin on conventional and exploratory acute and chronic kidney outcomes. We then assessed whether effects varied by predicted size of the acute eGFR dip on treatment initiation or among other key population subtypes using tests for heterogeneity and trend. The individual-level data were requested from Boehringer Ingelheim (Ingelheim, Germany). FINDINGS: Compared with placebo, allocation to empagliflozin reduced the risk of a marker of acute kidney injury (a ≥50% increase in serum creatinine in consecutive follow-up samples) by 20% (hazard ratio 0·80 [95% CI 0·72-0·88]; 1573 outcomes), acute kidney injury adverse events by 27% (0·73 [0·63-0·85]; 694 outcomes), a categorical chronic kidney disease progression outcome by 30% (0·70 [0·63-0·78]; 1403 outcomes), and kidney failure by 34% (0·66 [0·55-0·79]; 490 outcomes). Empagliflozin ...