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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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Abdulhamid MI, Aboona BE, Adam J, Adams JR, Agakishiev G, Aggarwal I, Aggarwal MM, Ahammed Z, Aitbaev A, Alekseev I, Anderson DM, Aparin A, Aslam S, Atchison J, Averichev GS, Bairathi V, Baker W, Cap JGB, Barish K, Bhagat P, Bhasin A, Bhatta S, Bordyuzhin IG, Brandenburg JD, Brandin AV, Cai XZ, Caines H, Sánchez MCDLB, Cebra D, Ceska J, Chakaberia I, Chan BK, Chang Z, Chatterjee A, Chen D, Chen J, Chen JH, Chen Z, Cheng J, Cheng Y, Choudhury S, Christie W, Chu X, Crawford HJ, Dale-Gau G, Das A, Daugherity M, Dedovich TG, Deppner IM, Derevschikov AA, Dhamija A, Di Carlo L, Dixit P, Dong X, Drachenberg JL, Duckworth E, Dunlop JC, Engelage J, Eppley G, Esumi S, Evdokimov O, Ewigleben A, Eyser O, Fatemi R, Fazio S, Feng CJ, Feng Y, Finch E, Fisyak Y, Flor FA, Fu C, Gao T, Geurts F, Ghimire N, Gibson A, Gopal K, Gou X, Grosnick D, Gupta A, Hamed A, Han Y, Harasty MD, Harris JW, Harrison-Smith H, He W, He XH, He Y, Hu C, Hu Q, Hu Y, Huang H, Huang HZ, Huang SL, Huang T, Huang X, Huang Y, Huang Y, Humanic TJ, Isenhower D, Isshiki M, Jacobs WW, Jalotra A, Jena C, Ji Y, Jia J, Jin C, Ju X, Judd EG, Kabana S, Kabir ML, Kalinkin D, Kang K, Kapukchyan D, Kauder K, Keane D, Kechechyan A, Kelsey M, Kimelman B, Kiselev A, Knospe AG, Ko HS, Kochenda L, Korobitsin AA, Kravtsov P, Kumar L, Kumar S, Elayavalli RK, Lacey R, Landgraf JM, Lebedev A, Lednicky R, Lee JH, Leung YH, Lewis N, Li C, Li W, Li X, Li Y, Li Y, Li Z, Liang X, Liang Y, Lin T, Liu C, Liu F, Liu G, Liu H, Liu H, Liu L, Liu T, Liu X, Liu Y, Liu Z, Ljubicic T, Llope WJ, Lomicky O, Longacre RS, Loyd EM, Lu T, Lukow NS, Luo XF, Luong VB, Ma L, Ma R, Ma YG, Magdy N, Mallick D, Margetis S, Matis HS, Mazer JA, McNamara G, Mi K, Minaev NG, Mohanty B, Mondal MM, Mooney I, Morozov DA, Mudrokh A, Nagy MI, Nain AS, Nam JD, Nasim M, Neff D, Nelson JM, Nemes DB, Nie M, Nigmatkulov G, Niida T, Nishitani R, Nogach LV, Nonaka T, Odyniec G, Ogawa A, Oh S, Okorokov VA, Okubo K, Page BS, Pak R, Pan J, Pandav A, Pandey AK, Panebratsev Y, Pani T, Parfenov P, Paul A, Perkins C, Pokhrel BR, Posik M, Protzman T, Pruthi NK, Putschke J, Qin Z, Qiu H, Quintero A, Racz C, Radhakrishnan SK, Raha N, Ray RL, Ritter HG, Robertson CW, Rogachevsky OV, Aguilar MAR, Roy D, Ruan L, Sahoo AK, Sahoo NR, Sako H, Salur S, Samigullin E, Sato S, Schmidke WB, Schmitz N, Seger J, Seto R, Seyboth P, Shah N, Shahaliev E, Shanmuganathan PV, Shao T, Sharma M, Sharma N, Sharma R, Sharma SR, Sheikh AI, Shen D, Shen DY, Shen K, Shi SS, Shi Y, Shou QY, Si F, Singh J, Singha S, Sinha P, Skoby MJ, Söhngen Y, Song Y, Srivastava B, Stanislaus TDS, Stewart DJ, Strikhanov M, Stringfellow B, Su Y, Sun C, Sun X, Sun Y, Sun Y, Surrow B, Svirida DN, Sweger ZW, Tamis A, Tang AH, Tang Z, Taranenko A, Tarnowsky T, Thomas JH, Tlusty D, Todoroki T, Tokarev MV, Tomkiel CA, Trentalange S, Tribble RE, Tribedy P, Tsai OD, Tsang CY, Tu Z, Tyler J, Ullrich T, Underwood DG, Upsal I, Van Buren G, Vasiliev AN, Verkest V, Videbæk F, Vokal S, Voloshin SA, Wang F, Wang G, Wang JS, Wang J, Wang X, Wang Y, Wang Y, Wang Y, Wang Z, Webb JC, Weidenkaff PC, Westfall GD, Wieman H, Wilks G, Wissink SW, Wu J, Wu J, Wu X, Wu X, Wu Y, Xi B, Xiao ZG, Xie G, Xie W, Xu H, Xu N, Xu QH, Xu Y, Xu Y, Xu Z, Xu Z, Yan G, Yan Z, Yang C, Yang Q, Yang S, Yang Y, Ye Z, Ye Z, Yi L, Yip K, Yu Y, Zha W, Zhang C, Zhang D, Zhang J, Zhang S, Zhang W, Zhang X, Zhang Y, Zhang Y, Zhang Y, Zhang Y, Zhang ZJ, Zhang Z, Zhang Z, Zhao F, Zhao J, Zhao M, Zhou C, Zhou J, Zhou S, Zhou Y, Zhu X, Zurek M, Zyzak M. Hyperon Polarization along the Beam Direction Relative to the Second and Third Harmonic Event Planes in Isobar Collisions at sqrt[s_{NN}]=200 GeV. PHYSICAL REVIEW LETTERS 2023; 131:202301. [PMID: 38039468 DOI: 10.1103/physrevlett.131.202301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/07/2023] [Accepted: 10/03/2023] [Indexed: 12/03/2023]
Abstract
The polarization of Λ and Λ[over ¯] hyperons along the beam direction has been measured relative to the second and third harmonic event planes in isobar Ru+Ru and Zr+Zr collisions at sqrt[s_{NN}]=200 GeV. This is the first experimental evidence of the hyperon polarization by the triangular flow originating from the initial density fluctuations. The amplitudes of the sine modulation for the second and third harmonic results are comparable in magnitude, increase from central to peripheral collisions, and show a mild p_{T} dependence. The azimuthal angle dependence of the polarization follows the vorticity pattern expected due to elliptic and triangular anisotropic flow, and qualitatively disagrees with most hydrodynamic model calculations based on thermal vorticity and shear induced contributions. The model results based on one of existing implementations of the shear contribution lead to a correct azimuthal angle dependence, but predict centrality and p_{T} dependence that still disagree with experimental measurements. Thus, our results provide stringent constraints on the thermal vorticity and shear-induced contributions to hyperon polarization. Comparison to previous measurements at RHIC and the LHC for the second-order harmonic results shows little dependence on the collision system size and collision energy.
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