Chronic kidney disease in type 2 diabetics and findings from the EMPA-KIDNEY study

Authors: Emil Martinka
Authors‘ workplace: Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa
Published in: Forum Diab 2023; 12(1): 39-45


Chronic kidney disease (CKD) is a frequent and serious complication in patients with type 2 diabetes mellitus, affecting 38 to 68% of patients according to data in the literature. In addition, the presence of CKD is associated with significantly higher morbidity and mortality rates and it also significantly complicates therapeutic approaches. As eGF values decrease and albuminuria increases, patient mortality from cardiovascular (CV) and other causes increases. It is therefore urgent for the diabetologist to address the issue of CKD both in terms of preventing its development (primary prevention) and slowing the progression of pre-existing CKD (secondary prevention), which involves intensive collaboration with a nephrologist. The EMPA-KIDNEY study, conducted in a population of patients with different causes of CKD, estimated glomerular filtration rate (eGF) and albuminuria levels, showed that treatment with empagliflozin, compared to placebo, contributed to a 28% reduction in the risk of CKD progression or death from CV causes, with no indications of significant safety issue. The benefit of empagliflozin treatment was demonstrated regardless of the presence or absence of diabetes and baseline eGF values. The outcomes were not influenced by CKD etiology (with the exception of a less convincing result in hypertensive/renovascular CKD), baseline HbA1c, the presence of previous CV disease or the use of RAASi at the time of randomization, which provides further support for a wider use of SGLT2i, also based on renal indication. However, the results of subgroup analyses showed that the effect of empagliflozin treatment was less evident in patients not receiving RAASi. Furthermore, the benefit of empagliflozin treatment was greater in patients with stage A3 albuminuria at the start of the study, whereas no significant difference between treatment with empagliflozin and placebo was observed in patients with normal or only mild albuminuria with a UACR of 30–300 mg/g, which was probably due to the lower risk of CKD progression in these patients. Finally, although the benefit of empagliflozin treatment was established independently of the presence / absence of diabetes mellitus, it was demonstrated to a lesser extent in patients without diabetes. These findings from the analyses of the effect of SGLT2i on CKD progression in relation to eGF, albuminuria, and the presence of diabetes, may therefore contribute to a more precise guidance on a more effective treatment as well as a better understanding of the mechanisms of renoprotection. In summary, we currently have three groups of drugs that have been proven to reduce the risk of progression of renal failure, each of them in a specific way. These groups involve the renin-angiotensin aldosterone system inhibitors (RAASi), the sodium-glucose cotransporter inhibitors (SGLT2i), and the non-steroidal mineralocorticoid receptor antagonist, finerenone. Empagliflozin is a drug from the SGLT2i group with the confirmed CV and renal benefit, making these drugs the preferred choice for the pharmacological treatment of DM2T, not only in patients with the already developed CV disease related to atherosclerosis, heart failure or CKD (secondary prevention), but also in patients receiving primary prevention. The EMPA-KIDNEY study provides further relevant evidence which significantly strengthens the preference for SGLT2i.


chronic kidney disease – CKD – empagliflosin – EMPA-KIDNEY


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Diabetology Endocrinology Internal medicine
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