Chronic kidney disease (CKD) is associated with increased cardiovascular (CV) and mortality risk, and healthcare costs. In established CKD, SGLT2 inhibitors have been reported to reduce its progression. The KDIGO ‘heat map’ is a clinical tool generated with 18 categories of kidney functions   based on estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio. which helps track patients with or at risk for CKD. Using the KDIGO risk group from worsening to improvement, the abstract presents the effect of empagliflozin on changes in CKD risk in the EMPA-REG OUTCOME study. 

The post hoc analysis included 7020 patients with T2D and established CVD randomized to receive empagliflozin 10, 25 mg (pooled for subsequent analyses) or placebo and were followed for a median of 3.1 yrs. KDIGO CKD risk was assessed at baseline and the last value on-treatment. The worsening risk was defined as a shift to a more advanced group (e.g., low to moderate); improvement in risk was defined as a shift to a less advanced group (e.g., high to moderate). Empagliflozin group had a lower percentage of patients with worsening in their KDIGO risk as compared to placebo in the low, moderate and high-risk baseline groups. (Empagliflozin: 26.0%, 24.4% and 23.3% and placebo: 32.1%, 31.5% and 36.3% respectively. The odds ratio (95% CI) of 0.70 (0.62, 0.78) for worsening risk across all baseline groups was in favour of empagliflozin treatment. Higher percentage of patients in the empagliflozin group showed improvement in the KDIGO CKD risk group as compared to placebo (Empagliflozin: 24.6%, 27.1% and 26.2% and placebo: 18.7%, 16.8% and 18.5%, respectively). The odds ratio (95% CI) of 1.56 (1.30, 1.86) for improved risk was in favour of empagliflozin group vs. placebo group. 

In conclusion, treatment with empagliflozin was associated with 30% lower odds of worsening and >50% higher odds of improvement in KDIGO CKD risk groups.