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Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Acharya S, Adamová D, Adler A, Aglieri Rinella G, Agnello M, Agrawal N, Ahammed Z, Ahmad S, Ahn SU, Ahuja I, Akindinov A, Al-Turany M, Aleksandrov D, Alessandro B, Alfanda HM, Alfaro Molina R, Ali B, Ali Y, Alici A, Alizadehvandchali N, Alkin A, Alme J, Alocco G, Alt T, Altsybeev I, Anaam MN, Andrei C, Andronic A, Anguelov V, Antinori F, Antonioli P, Anuj C, Apadula N, Aphecetche L, Appelshäuser H, Arata C, Arcelli S, Aresti M, Arnaldi R, Arsene IC, Arslandok M, Augustinus A, Averbeck R, Azmi MD, Badalà A, Baek YW, Bai X, Bailhache R, Bailung Y, Bala R, Balbino A, Baldisseri A, Balis B, Banerjee D, Banoo Z, Barbera R, Barile F, Barioglio L, Barlou M, Barnaföldi GG, Barnby LS, Barret V, Barreto L, Bartels C, Barth K, Bartsch E, Baruffaldi F, Bastid N, Basu S, Batigne G, Battistini D, Batyunya B, Bauri D, Bazo Alba JL, Bearden IG, Beattie C, Becht P, Behera D, Belikov I, Bell Hechavarria ADC, Bellini F, Bellwied R, Belokurova S, Belyaev V, Bencedi G, Beole S, Bercuci A, Berdnikov Y, Berdnikova A, Bergmann L, Besoiu MG, Betev L, Bhaduri PP, Bhasin A, Bhat MA, Bhattacharjee B, Bianchi L, Bianchi N, Bielčík J, Bielčíková J, Biernat J, Bigot AP, Bilandzic A, Biro G, Biswas S, Bize N, Blair JT, Blau D, Blidaru MB, Bluhme N, Blume C, Boca G, Bock F, Bodova T, Bogdanov A, Boi S, Bok J, Boldizsár L, Bolozdynya A, Bombara M, Bond PM, Bonomi G, Borel H, Borissov A, Bossi H, Botta E, Bouziani YEM, Bratrud L, Braun-Munzinger P, Bregant M, Broz M, Bruno GE, Buckland MD, Budnikov D, Buesching H, Bufalino S, Bugnon O, Buhler P, Buthelezi Z, Butt JB, Bysiak SA, Cai M, Caines H, Caliva A, Calvo Villar E, Camacho JMM, Camerini P, Canedo FDM, Carabas M, Carnesecchi F, Caron R, Castillo Castellanos J, Catalano F, Ceballos Sanchez C, Chakaberia I, Chakraborty P, Chandra S, Chapeland S, Chartier M, Chattopadhyay S, Chattopadhyay S, Chavez TG, Cheng T, Cheshkov C, Cheynis B, Chibante Barroso V, Chinellato DD, Chizzali ES, Cho J, Cho S, Chochula P, Christakoglou P, Christensen CH, 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A, Fasel M, Fecchio P, Feliciello A, Feofilov G, Fernández Téllez A, Ferrer MB, Ferrero A, Ferrero C, Ferretti A, Feuillard VJG, Filova V, Finogeev D, Fionda FM, Flor F, Flores AN, Foertsch S, Fokin I, Fokin S, Fragiacomo E, Frajna E, Fuchs U, Funicello N, Furget C, Furs A, Fusayasu T, Gaardhøje JJ, Gagliardi M, Gago AM, Galvan CD, Gangadharan DR, Ganoti P, Garabatos C, Garcia JRA, Garcia-Solis E, Garg K, Gargiulo C, Garibli A, Garner K, Gautam A, Gay Ducati MB, Germain M, Ghosh C, Ghosh SK, Giacalone M, Gianotti P, Giubellino P, Giubilato P, Glaenzer AMC, Glässel P, Glimos E, Goh DJQ, Gonzalez V, González-Trueba LH, Gorgon M, Gotovac S, Grabski V, Graczykowski LK, Grecka E, Grelli A, Grigoras C, Grigoriev V, Grigoryan S, Grosa F, Grosse-Oetringhaus JF, Grosso R, Grund D, Guardiano GG, Guernane R, Guilbaud M, Gulbrandsen K, Gundem T, Gunji T, Guo W, Gupta A, Gupta R, Guzman SP, Gyulai L, Habib MK, Hadjidakis C, Hamagaki H, Hamid M, Han Y, Hannigan R, Haque MR, Harris JW, Harton A, Hassan H, Hatzifotiadou D, Hauer P, Havener LB, Heckel ST, Hellbär E, Helstrup H, Hemmer M, Herman T, Herrera Corral G, Herrmann F, Herrmann S, Hetland KF, Heybeck B, Hillemanns H, Hills C, Hippolyte B, Hofman B, Hohlweger B, Honermann J, Hong GH, Horzyk A, Hosokawa R, Hou Y, Hristov P, Hughes C, Huhn P, Huhta LM, Hulse CV, Humanic TJ, Hushnud H, Hutson A, Hutter D, Iddon JP, Ilkaev R, Ilyas H, Inaba M, Innocenti GM, Ippolitov M, Isakov A, Isidori T, Islam MS, Ivanov M, Ivanov M, Ivanov V, Izucheev V, Jablonski M, Jacak B, Jacazio N, Jacobs PM, Jadlovska S, Jadlovsky J, Jaelani S, Jaffe L, Jahnke C, Jakubowska MJ, Janik MA, Janson T, Jercic M, Jevons O, Jimenez AAP, Jonas F, Jones PG, Jowett JM, Jung J, Jung M, Junique A, Jusko A, Kabus MJ, Kaewjai J, Kalinak P, Kalteyer AS, Kalweit A, Kaplin V, Karasu Uysal A, Karatovic D, Karavichev O, Karavicheva T, Karczmarczyk P, Karpechev E, Kashyap V, Kebschull U, Keidel R, Keijdener DLD, Keil M, Ketzer B, Khan AM, Khan S, Khanzadeev A, Kharlov Y, Khatun A, Khuntia A, Kileng B, Kim B, Kim C, Kim DJ, Kim EJ, Kim J, Kim JS, Kim J, Kim J, Kim M, Kim S, Kim T, Kimura K, Kirsch S, Kisel I, Kiselev S, Kisiel A, Kitowski JP, Klay JL, Klein J, Klein S, Klein-Bösing C, Kleiner M, Klemenz T, Kluge A, Knospe AG, Kobdaj C, Kollegger T, Kondratyev A, Kondratyuk E, Konig J, Konigstorfer SA, Konopka PJ, Kornakov G, Koryciak SD, Kotliarov A, Kovalenko O, Kovalenko V, Kowalski M, Králik I, Kravčáková A, Kreis L, Krivda M, Krizek F, Krizkova Gajdosova K, Kroesen M, Krüger M, Krupova DM, Kryshen E, Kučera V, Kuhn C, Kuijer PG, Kumaoka T, Kumar D, Kumar L, Kumar N, Kumar S, Kundu S, Kurashvili P, Kurepin A, Kurepin AB, Kushpil S, Kvapil J, Kweon MJ, Kwon JY, Kwon Y, La Pointe SL, La Rocca P, Lai YS, Lakrathok A, Lamanna M, Langoy R, Larionov P, Laudi E, Lautner L, Lavicka R, Lazareva T, Lea R, Legras G, Lehrbach J, Lemmon RC, León Monzón I, Lesch MM, Lesser ED, Lettrich M, Lévai P, Li X, Li XL, Lien J, Lietava R, Lim B, Lim SH, Lindenstruth V, Lindner A, Lippmann C, Liu A, Liu DH, Liu J, Lofnes IM, Loizides C, Loncar P, Lopez JA, Lopez X, López Torres E, Lu P, Luhder JR, Lunardon M, Luparello G, Ma YG, Maevskaya A, Mager M, Mahmoud T, Maire A, Malaev M, Malfattore G, Malik NM, Malik QW, Malik SK, Malinina L, Mal'Kevich D, Mallick D, Mallick N, Mandaglio G, Manko V, Manso F, Manzari V, Mao Y, Margagliotti GV, Margotti A, Marín A, Markert C, Martinengo P, Martinez JL, Martínez MI, Martínez García G, Masciocchi S, Masera M, Masoni A, Massacrier L, Mastroserio A, Mathis AM, Matonoha O, Matuoka PFT, Matyja A, Mayer C, Mazuecos AL, Mazzaschi F, Mazzilli M, Mdhluli JE, Mechler AF, Melikyan Y, Menchaca-Rocha A, Meninno E, Menon AS, Meres M, Mhlanga S, Miake Y, Micheletti L, Migliorin LC, Mihaylov DL, Mikhaylov K, Mishra AN, Miśkowiec D, Modak A, Mohanty AP, Mohanty B, Khan MM, Molander MA, Moravcova Z, Mordasini C, Moreira De Godoy DA, Morozov I, Morsch A, Mrnjavac T, Muccifora V, Muhuri S, Mulligan JD, Mulliri A, Munhoz MG, Munzer RH, Murakami H, Murray S, Musa L, Musinsky J, Myrcha JW, Naik B, Nair R, Nambrath AI, Nandi BK, Nania R, Nappi E, Nassirpour AF, Nath A, Nattrass C, Neagu A, Negru A, Nellen L, Nesbo SV, Neskovic G, Nesterov D, Nielsen BS, Nielsen EG, Nikolaev S, Nikulin S, Nikulin V, Noferini F, Noh S, Nomokonov P, Norman J, Novitzky N, Nowakowski P, Nyanin A, Nystrand J, Ogino M, Ohlson A, Okorokov VA, Oleniacz J, Oliveira Da Silva AC, Oliver MH, Onnerstad A, Oppedisano C, Ortiz Velasquez A, Oskarsson A, Otwinowski J, Oya M, Oyama K, Pachmayer Y, Padhan S, Pagano D, Paić G, Palasciano A, Panebianco S, Park H, Park J, Parkkila JE, Patra RN, Paul B, Pei H, Peitzmann T, Peng X, Pennisi M, Pereira LG, Pereira Da Costa H, Peresunko D, Perez GM, Perrin S, Pestov Y, Petráček V, Petrov V, Petrovici M, Pezzi RP, Piano S, Pikna M, Pillot P, Pinazza O, Pinsky L, Pinto C, Pisano S, Płoskoń M, Planinic M, Pliquett F, Poghosyan MG, Politano S, Poljak N, Pop A, Porteboeuf-Houssais S, Porter J, Pozdniakov V, Prasad 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Vislavicius V, Vodopyanov A, Volkel B, Völkl MA, Voloshin K, Voloshin SA, Volpe G, von Haller B, Vorobyev I, Vozniuk N, Vrláková J, Wagner B, Wang C, Wang D, Wegrzynek A, Weiglhofer FT, Wenzel SC, Wessels JP, Weyhmiller SL, Wiechula J, Wikne J, Wilk G, Wilkinson J, Willems GA, Windelband B, Winn M, Wright JR, Wu W, Wu Y, Xu R, Yadav A, Yadav AK, Yalcin S, Yamaguchi Y, Yamakawa K, Yang S, Yano S, Yin Z, Yoo IK, Yoon JH, Yuan S, Yuncu A, Zaccolo V, Zampolli C, Zanoli HJC, Zanone F, Zardoshti N, Zarochentsev A, Závada P, Zaviyalov N, Zhalov M, Zhang B, Zhang S, Zhang X, Zhang Y, Zhang Z, Zhao M, Zherebchevskii V, Zhi Y, Zhigareva N, Zhou D, Zhou Y, Zhu J, Zhu Y, Zinovjev G, Zurlo N. Measurements of Groomed-Jet Substructure of Charm Jets Tagged by D^{0} Mesons in Proton-Proton Collisions at sqrt[s]=13 TeV. PHYSICAL REVIEW LETTERS 2023; 131:192301. [PMID: 38000395 DOI: 10.1103/physrevlett.131.192301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/13/2023] [Accepted: 07/19/2023] [Indexed: 11/26/2023]
Abstract
Understanding the role of parton mass and Casimir color factors in the quantum chromodynamics parton shower represents an important step in characterizing the emission properties of heavy quarks. Recent experimental advances in jet substructure techniques have provided the opportunity to isolate and characterize gluon emissions from heavy quarks. In this Letter, the first direct experimental constraint on the charm-quark splitting function is presented, obtained via the measurement of the groomed shared momentum fraction of the first splitting in charm jets, tagged by a reconstructed D^{0} meson. The measurement is made in proton-proton collisions at sqrt[s]=13 TeV, in the low jet transverse-momentum interval of 15≤p_{T}^{jet ch}<30 GeV/c where the emission properties are sensitive to parton mass effects. In addition, the opening angle of the first perturbative emission of the charm quark, as well as the number of perturbative emissions it undergoes, is reported. Comparisons to measurements of an inclusive-jet sample show a steeper splitting function for charm quarks compared with gluons and light quarks. Charm quarks also undergo fewer perturbative emissions in the parton shower, with a reduced probability of large-angle emissions.
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