SOURCE: Wanner C, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016;375:323-334.

Sodium glucose transporter 2 (SGLT2) inhibitors are the newest class of medications approved to treat type 2 diabetes (T2DM). Although there have been isolated reports of acute kidney injury associated with SGLT2 treatment, FDA registration trials have noted a short-term decline in glomerular filtration rate, which returns to normal over ensuing weeks. The EMPA-REG trial (n = 7,020) was performed primarily as a cardiovascular safety trial for the SGLT2 inhibitor empagliflozin, as mandated for all new pharmacologic agents indicated for T2DM. In addition to the cardiovascular risk reduction reported in earlier published EMPA-REG results, renal outcomes were another important pre-specified endpoint.

New or worsening nephropathy was meaningfully reduced by empagliflozin treatment (hazard ratio = 0.61, a 39% reduction). Similarly, the incidence of a doubling of serum creatinine was reduced by almost half, and likelihood of initiation of renal replacement treatment was reduced by more than half.

In addition to favorable effects on glucose control and cardiovascular outcomes, treatment with empagliflozin was associated with meaningful reductions in adverse renal outcomes.