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Abstract

Empagliflozin in Patients with Chronic Kidney Disease: A Systematic Review and Meta-analysis

Background:

Chronic kidney disease (CKD) is a pervasive public health issue with rising prevalence worldwide, leading to significant socioeconomic burdens. The renal-protective efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2is), such as empagliflozin, in patients with CKD is a research focus in recent times.

Methods:

A systematic search was conducted up to June 2021 across MEDLINE, EMBASE, and Cochrane Library databases. The inclusion criteria were observational studies, randomized controlled trials (RCTs), and meta-analyses comparing the effects of empagliflozin on changes in estimated glomerular filtration rate (eGFR) compared with non-SGLT2i controls.

Results:

A total of 34 пол studies (10 RCTs, 13 observational studies, and 11 meta-analyses) were included, with 19,143 patients. The quality indicators were met in 59.3% (16 of 27) of studies. The pooled mean differences (95% CIs) indicated a modest but sustained improvement in eGFR of 2.47 mL/min/1.73 m2 (1.85–3.09) for 12 months, 2.70 mL/min/1.73 m2 (1.79–3.51) for 24 months and 3.19 mL/min/1.73 m2 (2.13–4.25) over 36 months. Furthermore, weight loss of 2.37 kg (2.01–2.73) was observed over 24 months with empagliflozin, without alterations in systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose (FG), HbA1c, and glycemic variability (GV).

Conclusions:

Empagliflozin, an SGLT2i, established a sustainable renal function increase in adults with varying degrees of basal CKD, without increasing the chance of overt hypoglyemic or cardiovascular events. Still, this analysis must be interpreted with caution towards cases' source limitations, and further research-based on real-world conditions and aiding intervention specificity is required.

Limitations:

This study had several limitations, including heterogeneous clinical trial participants' baseline data, only a few of not enough high-quality studies take into account glucose-losing and solute generation, and more head-to-head trials are needed to make a comparison of SGLT2 inhibitors. Also, potential adjustment contamination, such as the study plan (activity and diet), harsh treatment for cardioaffectors (PLT and HDL), gained baseline susceptibility, competing limitations, and how a GFR estimate diverse techniques accounts.

Future Directions:

Studies in the future should contribute real-world safety record, performed by cardiac magnetic resonance, solute equilibrium, or mass control denser focus analyses, high-quality information trials that distinct SGLT2 inhibitors, compare the decrease for CVD events between inhibitors, and assess disease-specific possibilities (fractures, PSTs) combined to presenting period empathizies, and assess if the eGFR increment similar to enhancing diabetic retinopathy.

Funding Information:

This research received no particular financial support. The content is solely the author's views and conclusion, and responsible for the methodology, data collection, synthesis, and analysis presented in the paper.
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Title: Empagliflozin and Renal Outcomes in Patients with Chronic Kidney Disease: A Comprehensive Analysis

Abstract:

Background: Chronic kidney disease (CKD) is a global public health concern associated with substantial morbidity and mortality. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), such as empagliflozin, have shown promising results in improving cardiovascular outcomes, but their renal protective effects remain under-investigated, particularly in patients without type 2 diabetes.

Methods: In this multicenter, double-blind, randomized controlled trial, we enrolled 3,567 patients with CKD (Stages 3-4) SNwith and without type 2 diabetes to receive either empagliflozin (10 mg or 25 mg) or placebo once daily. The primary composite outcome included a sustained decline in the estimated glomerular filtration rate (eGFR) of at least 50%, end-stage kidney disease (ESKD), or renal or cardiovascular death. Secondary outcomes assessed renal function trajectory, albuminuria, and cardiovascular events.

Results: During a median follow-up of 2.2 years, the primary composite outcome occurred in 161 patients (9.2%) in the empagliflozin group, as compared with 247 patients (14.4%) in the placebo group (HR 0.64, 95% CI, 0.54 to 0.76; P < 0.001), indicating a significant risk reduction. Patients who received empagliflozin exhibited a slower decline in eGFR and lower rates albuminuria progression. The effects were consistent across subgroups, irrespective of the presence or absence of type 2 diabetes. Additionally, empagliflozin-treated patients showed reduced risk for cardiovascular events. Adverse events, including diabetic ketoacidosis, genital infections, and volume depletion, were more frequent in the empagliflozin group but rarely led to treatment discontinuation.

Conclusions: In patients with CKD and with or without type 2 diabetes, empagliflozin treatment resulted in significant renal benefits and cardiovascular risk reduction. Empagliflozin may represent a novel therapeutic option for reno-protection in this high-risk population, calling for future research to investigate its mechanisms and further validate these findings.
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