Secondary analysis
Efficacy of Empagliflozin in Patients With Heart Failure Across Kidney Risk Categories
- Pooled secondary analysis of the EMPEROR-Reduced and EMPEROR-Preserved randomised trials
- subgroup analysis by Kidney Disease Improving Global Outcomes (KDIGO) risk category
Authors' conclusion
The benefit of empagliflozin on major heart failure events was not influenced by KDIGO categories. The magnitude of the renal effects of the drug depended on the approach used to calculate eGFR slopes.
Study context
- Population
- Patients with HF with reduced or preserved EF, grouped into KDIGO kidney risk categories (low, moderate, high, very high) by estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratiopooled analysis
- Participants
- 9,718 patients
- Comparison
- Empagliflozin vs placebo
- Primary endpoint
- CV death or HF hospitalization across KDIGO categories
Primary result
As reported in the abstract
CV death or HF hospitalization, by KDIGO risk category
Empagliflozin vs PlaceboHazard ratio (95% CI)
low risk (32.0%)
0.81(0.66–1.01)
moderate risk (29.1%)
0.63(0.52–0.76)
high risk (21.9%)
0.82(0.68–0.98)
very high risk (17.0%)
0.84(0.71–1.01)
Further findings
eGFR decline and composite kidney event by KDIGO category (Placebo)
- Higher-risk categories: slower eGFR decline but higher risk of composite kidney event
Rate of eGFR decline (chronic, total, unconfounded slope)
- Empagliflozin reduced rate of eGFR decline by every slope method; vs unconfounded slope, effect larger on chronic slope and smaller on total slope
- EMPEROR-Reduced: largest eGFR slope effect at lowest risk; not observed in EMPEROR-Preserved
Original publication
Efficacy of Empagliflozin in Patients With Heart Failure Across Kidney Risk Categories. J Am Coll Cardiol. Published 16 May 2023. doi:10.1016/j.jacc.2023.03.390
Summarised from the published abstract; every number is checked against it