Effects of empagliflozin on conventional and exploratory acute and chronic kidney outcomes: an individual participant-level meta-analysis
Authors' conclusion
SGLT2 inhibition reduces risk of acute and chronic kidney outcomes irrespective of the size of the acute dip in eGFR. Kidney benefits are evident irrespective of diabetes status, heart failure status, primary cause of kidney disease, and markers of severity of these diseases.
Study context
- Population
- Participants in EMPA-REG OUTCOME, EMPEROR-Reduced, EMPEROR-Preserved and EMPA-KIDNEY
- Participants
- 23,340 participants4 RCTs
- Comparison
- Empagliflozin vs placebo
- Outcome
- Conventional and exploratory acute and chronic kidney outcomes
Methodological detailstests for heterogeneity and trend
- Tests for heterogeneity and trend
Pooled result
As reported in the abstract
Empagliflozin vs PlaceboHazard ratio (95% CI)
Marker of AKI (≥50% increase in serum creatinine in consecutive samples); 1573 outcomes; 20% reduction
0.80(0.72–0.88)
AKI adverse events; 694 outcomes; 27% reduction
0.73(0.63–0.85)
Categorical CKD progression; 1403 outcomes; 30% reduction
0.70(0.63–0.78)
Kidney failure; 490 outcomes; 34% reduction
0.66(0.55–0.79)
- Slowing of chronic annual rate of estimated glomerular filtration rate (eGFR) decline
- 64% (95% CI 59-69)
- Slowing of off-treatment dip-free slope, post-hoc, subset of 10 630 participants (54-73)
- 64%
Further pooled results
- Kidney benefits similar in subgroups by predicted size of acute eGFR dip, and present irrespective of diabetes or HF status, kidney function, or albuminuria
Safety
| Outcome | HR (CI) | |
|---|---|---|
| AKI adverse events694 outcomes; 27% reduction | 0.73 (0.63–0.85) | |
| 0.512Hazard ratio (log scale) |
Original publication
Effects of empagliflozin on conventional and exploratory acute and chronic kidney outcomes: an individual participant-level meta-analysis. Lancet Diabetes Endocrinol. Published 11 October 2025. doi:10.
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