Large meta-analysis shows empagliflozin slows kidney progression and reduces risk among patients with multiple diseases

Presented by

Prof. William Herrington, University of Oxford, UK

Conference

ERA 2025

Empagliflozin versus placebo slowed eGFR decline and reduced the risk of developing kidney disease among patients with type 2 diabetes, heart failure, and kidney disease, according to a large meta-analysis which included more than 23,000 patients.

The meta-analysis presented by Prof. William Herrington (University of Oxford, UK) utilised individual participant-level data (n=23,340) from patients with type 2 diabetes, heart failure, or chronic kidney disease enrolled in 4 empagliflozin clinical trials [1]. All patients had eGFR measurements during the trials. Chronic eGFR measurements analysed as slopes were used to compare the effects of empagliflozin on chronic kidney disease progression.

Empagliflozin versus placebo resulted in a 64% (95% CI 59–69) reduction in the annual rate of decline in kidney function, as assessed by comparing the chronic eGFR slopes. Similarly, the analysis revealed a 30% reduction (HR 0.70; 95% CI 0.63–0.78) in the risk of kidney disease progression (composite of sustained decrease of ≥40% from baseline in eGFR or kidney failure). Among subgroups, patients with diabetes tended to have a greater benefit from empagliflozin in terms of chronic eGFR reduction slopes than patients without diabetes (74% vs 42%). A sustained benefit with empagliflozin was also seen in albuminuria, regardless of albuminuria level.

Prof. Herrington concluded that “after the acute dip, the rate of eGFR decline was reduced by about two-thirds, and the relative benefits seemed larger in people with diabetes, slowing progression by about three quarters. For the chronic kidney disease indication, neither the presence or absence of diabetes nor albuminuria should determine whether to treat people with SGLT2 inhibitors.”

Herrington W, et al. Impact of diabetes, albuminuria, acute eGFR dip, and disease severity on the effects of empagliflozin on progression of chronic kidney disease. 62nd ERA Congress, 4–7 June 2025, Vienna, Austria.

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