Effect of empagliflozin on albuminuria, eGFR and serum creatinine: updated results from the ABCD nationwide empagliflozin audit

Abstract

Introduction: Evidence from phase III and the EMPA-REG OUTCOME trials have demonstrated improvements in renal endpoints with empagliflozin use. The EMPA-KIDNEY trial is currently underway and is assessing whether there are benefits of empagliflozin in improving renal outcomes in people both with and without diabetes, and the mechanism has been suggested to be similar to that of ACE inhibitors with the haemodynamic effects of sodium-glucose co-transporter-2 inhibition reducing intraglomerular pressure.Aim: To assess the impacts of empagliflozin use on albuminuria and estimated glomerular filtration rate (eGFR) in a real-world UK-based audit.Methods: Data were collated via the ABCD nationwide audit programme, with analyses performed using either t-tests/ ANOVA or Wilcoxon signed rank/Kruskal–Wallis tests. Pre-specified stratified subgroup analyses by baseline eGFR and baseline albuminuria levels were also performed.Results: Our results demonstrated significant reductions in albuminuria across the population as a whole. When stratified by baseline albuminuria levels, those with microalbuminuria (30–300 μg/mg) or macroalbuminuria (>300 μg/mg) had significant improvements in urine albumin levels at 6-month (3–9-month) follow-up, with median changes of −17.7 μg/mg (p<0.0001; 95% CI −17.4 to −23.7) and 379.4 μg/mg (p=0.03; 95% CI −269.9 to −725.4), respectively. Across the population as a whole, eGFR reduced initially (at 6 months, −1.26 mL/min/1.73 m3; p<0.0001; 95% CI −0.87 to −1.64) before recovering to baseline by 24 months. When stratified by baseline eGFR, those with reduced renal function (eGFR <90) recovered quickest, with improvements in eGFR noted from baseline by 24 months.Conclusion: In this real-world analysis, the results are comparable to those in randomised controlled trials and are likely more generalisable to UK clinical practice. Unfortunately, we do not have clinical endpoints such as end-stage renal failure, renal death or dialysis as part of our dataset. Future audits could consider including these data to establish clinical as well as biochemical outcomes.