This podcast is intended for healthcare professionals only.
our guest
Dr. Manuel Alejandro Marquez Martinez (@Kidney_Power), internist and nephrologist, graduated from the Salvador Zubirán National Institute of Nutrition, attached to the Department of Internal Medicine, Nephrology at the Regional Hospital No. 6 in Tampico, Mexico.
Kidney Week
It is the annual congress organized by the American Society of Nephrology (ASN), and is the busiest meeting of the nephrology community. During the congress, in addition to sessions with selected topics, presentation of novel works in presentations or posters, the results of original studies that may become so important as to change clinical practice in all fields of medicine are presented to society. .
EMPA-KIDNEY: empagliflozin in patients with chronic kidney disease
What is this study about?: One of the most anticipated clinical trials by the nephrology medical community. Sodium glucose cotransporter type 2 (SGLT2) inhibitors work by blocking glucose reabsorption in the proximal tubule via this transporter, by blocking the cotransporter, they reduce sodium reabsorption, increasing sodium delivery to the macula densa it normalizes tubuloglomerular feedback and thus reduces intraglomerular pressure (ie, reduces glomerular hyperfiltration) through constriction of the abnormally dilated afferent arteriole. This and other pleiotropic mechanisms may explain the benefits of these drugs in slowing the progression of kidney disease in our patients.
Population
This study included patients with chronic kidney disease with an estimated glomerular filtration rate between 20 and 45 thousand/min/1.73 m2 with or without albuminuria and patients with an estimated glomerular filtration rate between 45 and 90 thousand/min/1.73 m2 with albuminuria (> 200 mg/g), with a 2-year follow-up. The study included 6,609 patients. Noting that only 40% had diabetes, unlike other studies with sodium-glucose cotransporter type 2 inhibitors that included almost all patients with diabetes. They did not include patients with kidney transplants or adult polycystic kidney disease.
A total of 5,037 patients were included, of whom 2,515 were randomized to the intervention (mean age: 61 years) and 2,522 to the control group (mean age: 62 years). A power of 90% was achieved to detect a mortality difference of 3.8%. About 40% were surgical patients, 42% with sepsis, APACHE average of 19%, and >75% had invasive mechanical ventilation.
interventions
It was a randomized, double-blind, placebo-controlled study using empagliflozin at a dose of 10 mg or placebo.
Results
In the results, progression to chronic kidney disease or cardiovascular death occurred in 432 of 3,304 patients (13.1%) in the empagliflozin group and in 558 of 3,305 patients (16.9%) in the placebo group (hazard ratio [HR]: 0.72: IC 95%: 0,78 a 0,95; p = 0.003). This benefit was observed (by analyzing subgroups of patients) regardless of whether or not the patient had diabetes, and across all three spectrums of albuminuria (<30 mg/g, 30 a 300 mg/g, > 300 mg/g).
conclusions
Sodium-glucose cotransporter type 2 inhibitors are consolidated as drugs that slow the progression towards end-stage chronic kidney disease, and with this study they ratify the power to use them in patients with or without diabetes, and in patients with established chronic kidney disease.
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EMPA-KIDNEY Collaborative Group; Herrington WG, Staplin N, Wanner C, Green JB, y cols. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 4 Nov 2022. doi: 10.1056/NEJMoa2204233. PMID: 36331190. Fuente