Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes
- Authors
- Wanner, Christoph; Inzucchi, Silvio E.; Lachin, John M.; Fitchett, David; von Eynatten, Maximilian; Mattheus, Michaela; Johansen, Odd Erik; Woerle, Hans J.; Broedl, Uli C.; Zinman, Bernard; EMPA-REG OUTCOME Investigators; Aizenberg, D.; Ulla, M.; Waitman, J.; De Loredo, L.; Farias, J.; Fideleff, H.; Lagrutta, M.; Maldonado, N.; Colombo, H.; Ferre Pacora, F.; Wasserman, A.; Maffei, L.; Lehman, R.; Selvanayagam, J.; d'Emden, M.; Fasching, P.; Paulweber, B.; Toplak, H.; Luger, A.; Drexel, H.; Prager, R.; Schnack, C.; Schernthaner, G.; Fliesser-Goerzer, E.; Kaser, S.; Scheen, A.; Van Gaal, L.; Hollanders, G.; Kockaerts, Y.; Capiau, L.; Chachati, A.; Persu, A.; Hermans, M.; Vantroyen, D.; Vercammen, C.; Van de Borne, P.; Mathieu, C.; Benhalima, K.; Lienart, F.; Mortelmans, J.; Strivay, M.; Vereecken, G.; Keymeulen, B.; Lamkanfi, F.; Chacra, A.; Eliaschewitz, F.; Zanella, M.; Faludi, A.; Bertolami, M.; Hayashida, C.; Nunes Salles, J.; Monte, O.; Dinato, M.; Manenti, E.; Rassi, N.; Halpern, A.; Lima Filho, M.; Ayoub, J.; Felicio, J.; Borges, J.; Gross, J.; Sgarbi, J.; Betti, R.; Tiburcio, A.; Purisch, S.; Schmid, H.; Takahashi, M.; Castro, M.; Rea, R.; Hissa, M.; Geloneze Neto, B.; Saraiva, J.; Henein, S.; Lochnan, H.; Imran, S. A.; Clayton, D.; Bayly, K.; Berlingieri, J.; Boucher, P.; Chan, Y.; Gupta, M.; Chehayeb, R.; Ouellett, A.; Ur, E.; Woo, V.; Zinman, B.; St Amour, E.; Terront Lozano, M.; Yupanqui Lozno, H.; Urina, M.; Lopez Jaramillo, P.; Jaramillo, N.; Sanchez, G.; Perez, G.; Tusek, S.; Mirosevic, G.; Goldoni, V.; Jurisic-Erzen, D.; Balasko, A.; Balic, S.; Drvodelic-Sunic, E.; Varzic, S. Canecki; Machkova, M.; Weiner, P.; Lastuvka, J.; Olsovsky, J.; Krarup, T.; Ridderstrale, M.; Tarnow, L.; Boesgaard, T. Wellov; Lihn, A. Saetre; Christensen, P.; Juhl, H.; Urhammer, S.; Lund, P.; Adojaan, B.; Jakovlev, U.; Lanno, R.; Lubi, M.; Marandi, T.; Gouet, D.; Courreges, J.; Zaoui, P.; Choukroun, G.; Petit, C.; Formagne, L.; Estour, B.; Mabire, P.; Daugenet, C.; Lemarie, B.; Clavel, S.; Aure, P.; Remaud, P.; Halimi, J.; Hadjadj, S.; Couffinhal, T.; Glonti, S.; Metreveli, D.; Lominadze, Z.; Giorgadze, E.; Burtchuladze, T.; Javashvili, L.; Kurashvili, G.; Kurashvili, R.; Virsaladze, D.; Nadareishvili, L.; Khomasuridze, A.; Cahill, T.; Green, F.; MacRury, S.; Waldron, M.; Middleton, A.; McKnight, J.; Pearson, E.; Butler, M.; Choksi, M.; Caldwell, I.; Farmer, I.; Wyatt, N.; Patrick, J.; O'Brien, I.; Devers, M.; Bousboulas, S.; Pappas, S.; Piaditis, G.; Vryonidou, A.; Tentolouris, N.; Karamitsos, K.; Manes, C.; Benroubi, M.; Avramidis, I.; Ozaki, R.; Tan, K.; Siu, S.; Tsang, C.; Dudas, M.; Nagy, K.; Salamon, C.; Ip, T.; Geroo, L.; Patkay, J.; Tabak, A.; Juhasz, F.; Szentpeteri, I.; Tamas, G.; Ghaisas, N.; Bantwal, G.; Mohan, V.; Gupta, J.; Sadhu, N.; Kulkarni, A.; Garg, N.; Reddy, S.; Deshpande, N.; Gutlapalli, K.; Pillai, M.; Premchand, R.; Badgandi, M.; Jain, S.; Aravind, S.; Shamanna, P.; Pandey, A.; Gupta, S.; Pramono, B.; Saksono, H. Dante; Agung, P.; Wahono, S. Djoko; Suastika, K.; Tanggo, Y.; Juwana, Y.; Siswanto, B.; Adawi, F.; Efrati, S.; Mazen, E.; Bashkin, A.; Herskovits, T.; Jaffe, A.; Schiff, E.; Wainstein, J.; Taddei, S.; Aiello, A.; Arca, M.; Calabro, P.; Cignarelli, M.; Fioretto, P.; Reggiani, G. Marchesini; Gnasso, A.; Marchionni, N.; Marsilii, A.; Bucci, M.; Mezzetti, A.; Pozzilli, P.; Colivicchi, F.; Santini, M.; Moro, E.; Toscano, V.; Fucili, A.; Semplicini, A.; Monno, S.; Furui, K.; Higashiue, S.; Hiramatsu, N.; Kawamitsu, K.; Takenaka, T.; Takahashi, H.; Hojo, F.; Onishi, Y.; Izumino, K.; Okubo, M.; Wakida, Y.; Kondo, Y.; Hieshima, K.; Jinnouchi, H.; Suzuki, A.; Ito, M.; Park, S.; Kim, Y.; Hong, T.; Park, H.; Gwon, H.; Kim, H.; Kang, K.; Jeong, M.; Seung, K.; Lim, D.; Rha, S.; Tahk, S.; Yang, J.; Yoon, J.; Shin, M.; Kim, D.; Jeong, J.; Ahmad, N. Nik; Mustafa, N.; Mohamed, W. Wan; Fung, Y.; Ghani, R. Abdul; Chandramouli, A.; Chee, K.; Kadir, K. Abdul; Ling, K.; Abu Hassan, M.; Foo, S.; Lee, S.; Garcia Hernandez, P.; Aguilar-Salinas, C.; Vidrio Velazquez, M.; Flores, F.; Alpizar Salazar, M.; Micher Escalante, D.; Garcia Soria, M.; Cardona Munoz, E.; Storms, G.; Schaper, N.; Kooy, A.; Krekels, M.; van Bemmel, T.; Verhoeven, R.; Mulder, H.; Oldenburg-Ligtenberg, P.; Gonkel, F.; de Jong, A.; van Soest, J.; Viergever, P.; Mevissen, H.; Lochorn, G.; Zwiers, G.; Hoogslag, P.; Ronner, E.; Nierop, P.; Al-Windy, N.; Kragten, J.; Dekelver, P.; Benatar, J.; Krebs, J.; Scott, R.; Heggen, E.; Berz, A.; Fossum, C.; Hurtig, U.; Langslet, G.; Baranowski, M.; Sparby, J.; Karlsson, T.; Karlsson, Thomas; Delgado Torres, C.; Rodriguez Escudero, A.; Lisson, R.; Allemant Maldonado, A.; Gallardo Rojas, W.; Gonzales Bravo, L.; Lema Osores, J.; Farfan, J.; Zapata, L.; Godoy Junchaya, J.; Roldan Concha, Y.; Urquiaga Calderon, J.; Sy, R.; Tan, G.; Aquitania, G.; De Los Santos, G.; Panelo, A.; Roderos, O.; Rosales, R.; Toledo, R.; Liwag, A.; Ramoncito, H.; Skokowska, E.; Krzyzagorska, E.; Ogorek, M.; Wojnowski, L.; Spyra, J.; Konieczny, M.; Piesiewicz, W.; Kus, W.; Ocicka-Kozakiewicz, A.; Orlowska-Kunikowska, E.; Zmuda, W.; Duarte, S.; Leitao, A.; Monteiro, P.; Rita, H.; Salgado, V.; Pinto, L.; Queiros, J.; Teixeira, J.; Rogado, C.; Duarte, R.; Sobral do Rosario, F.; Silva, A.; Andrade, L.; Velez, M.; Brazao, M.; Istratoaie, O.; Lichiardopol, R.; Catrinoiu, D.; Militaru, C.; Zetu, C.; Barbonta, D.; Cosma, D.; Crisan, C.; Pop, L.; Esip, V.; Khetagurova, F.; Petrov, A.; Arutyunov, G.; Boyarkin, M.; Agafyina, A.; Vorokhobina, N.; Petunina, N.; Libov, I.; Zalevskaya, A.; Nikolaev, K.; Barbarash, O.; Potemkin, V.; Bystrova, A.; Krasilnikova, E.; Barbarich, V.; Chumakova, G.; Tarasov, N.; Meleshkevich, T.; Zateyshchikov, D.; Lantseva, O.; Belenkiy, D.; Obrezan, A.; Rossolko, L.; Fillipova, E.; Yakhontova, P.; Khokhlov, A.; Tan, R.; Sum, C.; Chang, H.; Distiller, L.; Pretorius, M.; Nortje, H.; Mitha, E.; Burgess, L.; Blignaut, S.; Venter, T.; Moodley, R.; Lombaard, J.; Govind, U.; Naidoo, V.; Mookadam, M.; Engelbrecht, J.; Omar, M.; Jurgens, J.; Podgorski, G.; Vawda, H.; Naidoo, D.; Emanuel, S.; Roodt, A.; Amod, A.; Van Zyl, L.; Segura, J.; Brito, M.; Fernandez-Cruz, A.; Artola, S.; Iglesias, R.; Toural, E.; Garcia-Ortiz, L.; Saban, J.; Mesa, J.; Vidal, J.; Linares, J.; del Canizo, F.; Rigla, M.; Suarez, C.; Llorente, I.; Moreno, B.; Antoli, A.; Gomez Peralta, F.; Iglesias, M.; Pereg, V.; de Teresa, L.; Camafort, M.; Trescoli, C.; Satarasinghe, R.; Somasundaram, N.; Siyambalapitiya, S.; Antonypillai, C.; Bulugahapitiya, D.; Medagama, U.; Huang, C.; Lu, Y.; Hwang, J.; Chiang, C.; Wen, M.; Chen, J.; Lai, W.; Chang, K.; Wang, J.; Yeh, H.; Kriangsak, P.; Deerochanawong, C.; Suwanwalaikorn, S.; Mangklabruks, A.; Kaewsuwanna, P.; Piyayotai, D.; Iabluchanskyi, M.; Samoylov, O.; Godlevska, O.; Kovalyova, O.; Voloshyna, O.; Tseluyko, V.; Zotov, S.; Vykhovanyuk, I.; Dulgeroff, A.; Mayfield, R.; Zaniewski-Singh, M.; Ullal, J.; Aloi, J.; De La Rosa, R.; Mosely, J.; Wittmer, B.; Aronoff, S.; Rosenfeld, J.; Seidner, M.; Warren, M.; Fishman, N.; Weiss, R.; Arif, A.; Sandberg, M.; Lewis, D.; Ball, E.; Graf, R.; Breton, C.; Tamayo, R.; Richards, R.; Cefalu, W.; Uwaifo, G.; Zayour, D.; Hoffman, J.; Fitz-Patrick, D.; Khan, B.; Blaze, K.; Bressler, P.; Halpern, S.; Chappell, D.; Bergenstal, R.; Cuddihy, R.; Matfin, G.; Freedman, Z.; Gonzalez-Campoy, J.; Lerman, S.; Rendell, M.; Sitar, S.; Reeves, M.; Howard, T.; Soufer, J.; Miranda-Palma, B.; Laliotis, A.; Shomali, M.; Teltser, M.; Hurley, D.; Morawski, E.; Cherlin, R.; Houchin, V.; Welch, M.; Goytia-Leos, D.; Syed, M.; Kowaloff, E.; Weinrauch, L.; Peniston, J.; Brockmyre, A.; First, B.; Feld, L.; Huffman, D.; Nassim, O.; Gottschlich, G.; Patel, A.; Knopke, C.; Hernandez, M.; Diaz, J.; Giugliano, G.; Nicasio, J.; Eagerton, D.; Huntley, R.; Reed, J., III; Magee, M.; Hippert, R.; Sofley, C., Jr.; Alzohaili, O.; Levins, P.; Anspach, R.; Shah, S.; Brusco, O.; Naidu, J.; Lindenbaum, J.; Jacks, R.; Hammond, G.; Arena, C.; Saxman, K.; Mach, M.; Kerstein, H.; Kereiakes, D.; Wahlen, J.; Wehmeier, K.; Chaykin, L.; Rothman, J.; Fogelfeld, L.; Stroger, John H., Jr.; Bittar, N.; Rosenstock, J.; Kayne, D.; Navarro, J.; Colfer, H.; Mokshagundam, S.; Shandilya, L.; Connery, L.; Wysham, C.; Dela Llana, A.; Jardula, M.; MacAdams, M.; Flippo, G.; Heurich, E.; Curtis, C.; Sanders, D.; Rawls, R.; Velazquez, F.; Osea, E.; Mahood, K.; Feldman, G.; Eder, F.; Riley, E.; Fowler, W.; Jain, M.; Shepard, M.; Schear, M.; Barker, B.; Strout, C.; Obiekwe, O.; Shanik, M.; Green, C.; Blakney, E.; Roberson, K.; Bretton, E.; Pish, R.; Kaveh, K.; Maynard, B.; Barager, W.; Soldyshev, R.; Austin, B.; Parmar, P.; Simpson, R.; Chauhan, A.; Kasper, J.; Burr, R.; Patel, N.; Mariano, H.; Pluto, T.; Bratcher, C.; Juarez, M.; Levinson, L.; Awad, A.; Longshaw, K.; Hoffman, K.; Richwine, R.; Molter, D.; Boscia, J., III; Kowalyk, S.; Lemis, P.; Liss, J.; Orr, R.; Riser, J.; Wood, J.; Ubani, A.; Paine, W.; Hassani, F.; Miranda, F.; Hansen, V.; Hansen, Val R.; Farris, N.; Bowden, R.; Ajani, D.; Maw, K.; Andersen, J.; Bergman, B.; Dunmyer, S.; Brandon, D.; Anderson, M.; Bononi, P.; Prawer, J.; Seidman, B.; Cruz, H.; Wilks, K.; DiSanto, L.; Buynak, R.; Christensen, T.; Denker, P.; Koppel, W.; Stedman, M.; Lewy-Alterbaum, L.; Karim, S.; Shapiro, J.; Gardner, T.; Oskin, T.; Gabra, N.; Malano, J.
- Issue Date
- Jul-2016
- Publisher
- Massachusetts Medical Society
- Citation
- New England Journal of Medicine, v.375, no.4, pp 323 - 334
- Pages
- 12
- Indexed
- SCI
SCIE
SCOPUS
- Journal Title
- New England Journal of Medicine
- Volume
- 375
- Number
- 4
- Start Page
- 323
- End Page
- 334
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/52263
- DOI
- 10.1056/NEJMoa1515920
- ISSN
- 0028-4793
1533-4406
- Abstract
- BACKGROUND
Diabetes confers an increased risk of adverse cardiovascular and renal events. In the EMPA-REG OUTCOME trial, empagliflozin, a sodium–glucose cotransporter 2 inhibitor, reduced the risk of major adverse cardiovascular events in patients with type 2 diabetes at high risk for cardiovascular events. We wanted to determine the long-term renal effects of empagliflozin, an analysis that was a prespecified component of the secondary microvascular outcome of that trial.
METHODS
We randomly assigned patients with type 2 diabetes and an estimated glomerular filtration rate of at least 30 ml per minute per 1.73 m2 of body-surface area to receive either empagliflozin (at a dose of 10 mg or 25 mg) or placebo once daily. Prespecified renal outcomes included incident or worsening nephropathy (progression to macroalbuminuria, doubling of the serum creatinine level, initiation of renal-replacement therapy, or death from renal disease) and incident albuminuria.
RESULTS
Incident or worsening nephropathy occurred in 525 of 4124 patients (12.7%) in the empagliflozin group and in 388 of 2061 (18.8%) in the placebo group (hazard ratio in the empagliflozin group, 0.61; 95% confidence interval, 0.53 to 0.70; P<0.001). Doubling of the serum creatinine level occurred in 70 of 4645 patients (1.5%) in the empagliflozin group and in 60 of 2323 (2.6%) in the placebo group, a significant relative risk reduction of 44%. Renal-replacement therapy was initiated in 13 of 4687 patients (0.3%) in the empagliflozin group and in 14 of 2333 patients (0.6%) in the placebo group, representing a 55% lower relative risk in the empagliflozin group. There was no significant between-group difference in the rate of incident albuminuria. The adverse-event profile of empagliflozin in patients with impaired kidney function at baseline was similar to that reported in the overall trial population.
CONCLUSIONS
In patients with type 2 diabetes at high cardiovascular risk, empagliflozin was associated with slower progression of kidney disease and lower rates of clinically relevant renal events than was placebo when added to standard care. (Funded by the Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance; EMPA-REG OUTCOME ClinicalTrials.gov number, NCT01131676. opens in new tab.)
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