Cardiac and kidney benefits of empagliflozin in heart failure across the spectrum of kidney function: Insights from the EMPEROR-Preserved trial.
In a prespecified EMPEROR-Preserved analysis, empagliflozin reduced cardiovascular death or heart failure hospitalization and slowed eGFR decline in patients with heart failure and preserved ejection fraction, with benefits consistent across the full spectrum of kidney function down to an eGFR of 20 mL/min/1.73 m2.
Background
EMPEROR-Preserved established that empagliflozin improved clinical outcomes in patients with heart failure with preserved ejection fraction (ejection fraction greater than 40%). This prespecified analysis examined the effect of empagliflozin on cardiovascular and kidney outcomes across the spectrum of kidney function, since chronic kidney disease is common in this population.
Study design
A total of 5988 patients were randomized to empagliflozin or placebo, of whom 3198 (53.5%) had chronic kidney disease at baseline, defined as an eGFR below 60 mL/min/1.73 m2 or a urine albumin-to-creatinine ratio above 300 mg/g. Outcomes included the composite of cardiovascular death or first heart failure hospitalization, total heart failure hospitalizations, eGFR slope, and an exploratory composite kidney outcome, over a median follow-up of 26.2 months.
Key findings
Empagliflozin reduced the primary outcome regardless of CKD status (with CKD: hazard ratio 0.80, 95% CI 0.69-0.94; without CKD: hazard ratio 0.75, 95% CI 0.60-0.95; interaction p = 0.67) and slowed the rate of eGFR decline in both groups. It did not reduce the prespecified composite kidney outcome but slowed progression to macroalbuminuria and reduced the risk of acute kidney injury. Effects were consistent across five baseline eGFR categories, down to an eGFR of 20 mL/min/1.73 m2.
Clinical implications
The benefit and safety of empagliflozin were consistent across a wide range of kidney function in patients with heart failure with preserved ejection fraction, and the drug was well tolerated independent of CKD status. These findings support use of empagliflozin in this population even in patients with substantially impaired kidney function.
Category
Research
Source
Eur J Heart Fail
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