scholarly journals Empagliflozin and Kidney Function Decline in Patients with Type 2 Diabetes: A Slope Analysis from the EMPA-REG OUTCOME Trial

2018 ◽  
Vol 29 (11) ◽  
pp. 2755-2769 ◽  
Author(s):  
Christoph Wanner ◽  
Hiddo J.L. Heerspink ◽  
Bernard Zinman ◽  
Silvio E. Inzucchi ◽  
Audrey Koitka-Weber ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Kidney Function ◽  
Treatment Initiation ◽  
Standard Of Care ◽  
Random Coefficient Models ◽  
Random Intercept ◽  
Outcome Trial ◽  
Kidney Function Decline

BackgroundEmpagliflozin slowed the progression of CKD in patients with type 2 diabetes and cardiovascular disease in the EMPA-REG OUTCOME Trial. In a prespecified statistical approach, we assessed treatment differences in kidney function by analyzing slopes of eGFR changes.MethodsParticipants (n=7020) were randomized (1:1:1) to empagliflozin 10 mg/d, empagliflozin 25 mg/d, or placebo added to standard of care. We calculated eGFR slopes using random-intercept/random-coefficient models for prespecified study periods: treatment initiation (baseline to week 4), chronic maintenance treatment (week 4 to last value on treatment), and post-treatment (last value on treatment to follow-up).ResultsCompared with placebo, empagliflozin was associated with uniform shifts in individual eGFR slopes across all periods. On treatment initiation, adjusted mean slope (eGFR change per week, ml/min per 1.73 m2) decreased with empagliflozin (−0.77; 95% confidence interval, −0.83 to −0.71; placebo: 0.01; 95% confidence interval, −0.08 to 0.10; P<0.001). However, annual mean slope (ml/min per 1.73 m2 per year) did not decline with empagliflozin during chronic treatment (empagliflozin: 0.23; 95% confidence interval, 0.05 to 0.40; placebo: −1.46; 95% confidence interval, −1.74 to −1.17; P<0.001). After drug cessation, the adjusted mean eGFR slope (ml/min per 1.73 m2 per week) increased and mean eGFR returned toward baseline level only in the empagliflozin group (0.56; 95% confidence interval, 0.49 to 0.62; placebo −0.02; 95% confidence interval, −0.12 to 0.08; P<0.001). Results were consistent across patient subgroups at higher CKD risk.ConclusionsThe hemodynamic effects of empagliflozin, associated with reduction in intraglomerular pressure, may contribute to long-term preservation of kidney function.

Progression of diabetic kidney disease and trajectory of kidney function decline in Chinese patients with Type 2 diabetes

2019 ◽  
Vol 95 (1) ◽  
pp. 178-187 ◽  
Author(s):  
Guozhi Jiang ◽  
Andrea On Yan Luk ◽  
Claudia Ha Ting Tam ◽  
Fangying Xie ◽  
Bendix Carstensen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Kidney Function ◽  
Diabetic Kidney Disease ◽  
Chinese Patients ◽  
Diabetic Kidney ◽  
Kidney Function Decline

scholarly journals Association of dietary fat composition with kidney function decline in patients with type 2 diabetes

2015 ◽  
Vol 7 (S1) ◽  
Author(s):  
Ana Luiza Teixeira dos Santos ◽  
Camila Kümmel Duarte ◽  
Maira Zoldan ◽  
Manoella Freitas Santos ◽  
Lorenzo Catucci Boza ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Dietary Fat ◽  
Fat Composition ◽  
Kidney Function Decline

scholarly journals Lipid and inflammatory biomarkers and kidney function decline in type 2 diabetes

Diabetologia ◽  
2009 ◽  
Vol 53 (2) ◽  
pp. 263-267 ◽  
Author(s):  
J. Lin ◽  
F. B. Hu ◽  
C. Mantzoros ◽  
G. C. Curhan
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Inflammatory Biomarkers ◽  
Kidney Function Decline

Biomarkers of Inflammation and Glomerular Filtration Rate in Individuals with Recent-Onset Type 1 and Type 2 Diabetes

2020 ◽  
Vol 105 (12) ◽  
pp. e4370-e4381 ◽  
Author(s):  
Haifa Maalmi ◽  
Christian Herder ◽  
Klaus Strassburger ◽  
Sofia Urner ◽  
Karin Jandeleit-Dahm ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Filtration Rate ◽  
Inflammatory Biomarkers ◽  
Cross Sectional ◽  
Recent Onset ◽  
Lower Baseline ◽  
Kidney Function Decline

Abstract Context While inflammation has been associated with kidney function in long-standing diabetes, its possible association in newly diagnosed diabetes is unknown. Objective To investigate cross-sectional and prospective associations between biomarkers of inflammation and kidney function in recent-onset diabetes. Methods The study included individuals with type 1 and type 2 diabetes with known diabetes duration of &lt;1 year from the German Diabetes Study. Baseline serum concentrations of 74 biomarkers were measured using proximity extension assay technology and their associations with estimated glomerular filtration rate (eGFR) and kidney function decline over 5 years were tested using multiple linear and logistic regression analysis. Results The cross-sectional analysis included 165 individuals with type 1 diabetes and 291 with type 2 diabetes. Baseline eGFR was higher in type 1 compared with type 2 diabetes (102 ± 15 vs 90 ± 16 mL/min/1.73 m2; P &lt; 0.0001). After full adjustment for covariates and multiple testing, 7 biomarkers were associated with lower baseline eGFR in type 1 diabetes and 24 were associated with lower baseline eGFR in type 2 diabetes. Among these biomarkers, 6 biomarkers (CD5, CCL23, CST5, IL-10RB, PD-L1, TNFRSF9) were inversely associated with eGFR in both diabetes types. The prospective analysis did not detect associations between inflammatory biomarkers and kidney function decline. No evidence of an interaction between diabetes type and inflammatory biomarkers was found. Conclusion Several biomarkers of inflammation associate with lower baseline eGFR in recent-onset type 1 and type 2 diabetes, but do not associate with kidney function loss during the first 5 years after the diagnosis of diabetes.

Rate of Decline in Kidney Function and Age-of-Onset or Duration of Type 2 Diabetes

2021 ◽  
Author(s):  
Oyunchimeg Buyadaa ◽  
Agus Salim ◽  
Jedidiah I Morton ◽  
Dianna J Magliano ◽  
Jonathan E Shaw
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Estimated Glomerular Filtration Rate ◽  
Middle Age ◽  
Age Of Onset ◽  
Duration Of Diabetes ◽  
Rate Of Decline ◽  
Kidney Function Decline ◽  
Egfr Decline

Abstract The association between rate of kidney function decline and age-of-onset or duration of type 2 diabetes has not been well investigated. We aimed to examine whether rates of estimated glomerular filtration rate (eGFR) decline differ by age-of-onset or duration in people with type 2 diabetes. Using the Action to Control Cardiovascular Risk in Diabetes study dataset rates of eGFR decline were calculated using a joint-longitudinal-survival model and were compared among groups defined by the age-of-onset (0–39, 40–49, 50–59, 60–69 and > 70 years) and 5-year diabetes duration intervals. Changes in renal function were evaluated using median of 6 (interquartile range: 3–10) eGFR measurements per person. eGFR decline was the slowest in those with an age-at-diagnosis of 50 − 59 years or those with duration of diabetes < 5 years. The rates of eGFR decline were significantly greater in those with an age-of-onset < 40 years or those with duration of diabetes > 20 years compared to those diagnosed at 50 − 59 or those with duration of diabetes < 5 years (-1.98 vs -1.61 ml/min/year; -1.82 vs -1.52 ml/min/year; respectively (p < 0.001). Those with youngest age-of-onset or longest duration of type 2 diabetes had more rapid declines in eGFR compared to those diagnosed at middle age or those with shorter duration of diabetes.

P6270Empagliflozin reduces the total burden of first and recurrent hospitalisations in patients with type 2 diabetes and established cardiovascular disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D McGuire ◽  
B Zinman ◽  
S E Inzucchi ◽  
S D Anker ◽  
C Wanner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Recurrent Events ◽  
Negative Binomial ◽  
Cox Regression ◽  
Standard Of Care ◽  
History Of ◽  
Outcome Trial ◽  
Cv Disease ◽  
Total Burden

Abstract Background and aims The EMPA-REG OUTCOME trial included patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular (CV) disease. Empagliflozin reduced the risk of 3-point major adverse CV events (MACE; composite of CV death, myocardial infarction [MI], or stroke) by 14%, CV death by 38% and hospitalisation for heart failure (HF) by 35% vs placebo in analyses of time to first event. We assessed the effect of empagliflozin on all-cause hospitalisation in post-hoc analyses of all (first and recurrent) events. Materials and methods Patients were randomised to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo in addition to standard of care. We assessed the effects of empagliflozin pooled vs placebo on first event of all-cause hospitalisation using Cox regression and all (first and recurrent) events of all-cause hospitalisation using a negative binomial model. Results A total of 7020 patients were treated (4687 empagliflozin; 2333 placebo, mean [SD] age 63 [9] years, 71% male, 47% with history of MI, 23% with history of stroke, 10% with HF). In this analysis, 1725/4687 (36.8%) empagliflozin patients and 925/2333 (39.6%) placebo patients experienced an event leading to hospitalisation. The adjusted hazard ratio (HR; 95% CI) vs placebo for first all-cause hospitalisation using the Cox regression model was 0.89 (0.82, 0.96; p=0.0033; Figure); In analyses of all (first and recurrent) hospitalisation events, there were 3168 events in the empagliflozin group and 1863 in the placebo group. The adjusted event rate ratio (95% CI) vs placebo was 0.83 (0.76, 0.91; p<0.0001; Figure). Conclusion In the EMPA-REG OUTCOME trial, risk reductions with empagliflozin were seen in both first and all hospitalisation events and were numerically more favourable in analyses of all events vs analyses of first events. These analyses expand on the favourable CV effects of empagliflozin by also showing a reduction in the total burden of hospitalisation events in patients with T2D and established CV disease. Acknowledgement/Funding Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance

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