Thread by @BevTchangMD

Empagliflozin is now my go-to SGLT2i for pts with #diabetes and #CKD or #CHF, over cana or dapa or ertu.

Why?

A: EMPA-KIDNEY: nejm.org/doi/full/10.10…
and EMPEROR-Reduced and EMPEROR-Preserved
1/

EMPA-KIDNEY is unique because it enrolled GFR 20-45 *without* proteinuria whereas others (DAPA CKD, CANVAS) enrolled pts with CKD+proteinuria, though DAPA-CKD conducted a subgroup analysis for UACR < and > 1000

The primary outcome was a composite of progression of #kidney disease (defined as #ESRD, a sustained decrease in eGFR to <10, a sustained decrease in eGFR of ≥40% from baseline, or death
from #renal causes) or death from #cardiovascular causes

Benefit was demonstrated irrespective of #diabetes presence, across all GFRs, and UACR > 300
(DAPA-CKD showed benefit with UACR > or < 1000 in subgroup analysis)
No benefit demonstrated with little or no microalbuminuria (UACR<30)

EMPEROR-Reduced (nejm.org/doi/full/10.10…) demonstrated a reduction in the primary outcome of #cardiovascular death or hospitalization for worsening #heart failure in pts with EF < or = 40%, irrespective of #diabetes status

EMPEROR-Preserved (nejm.org/doi/full/10.10…) showed reduction in the same primary outcome in pts with EF>40%

Keep in mind that ALL of these empagliflozin trials only used the 10 mg/d dose, not the max of 25 mg/d

#diabetes #heart #cardiac #kidney #nephrology #cardiology #endocrinology