Nearly a decade ago, preliminary evidence began to emerge suggesting that a new class of drugs created for people who have diabetes may also be beneficial for people with kidney disease who don’t have diabetes. Now, the results of a number of large, randomized trials – including the most recent EMPA-KIDNEY trial – have confirmed that sodium-glucose transport 2 (SGLT2) inhibitors can slow the progression of kidney disease, and reduce the risk of cardiovascular death in this latter population.
SGLT2 inhibitors were first approved to treat diabetes, but researchers believed they might be helpful in other contexts as well.
“Because of the ways they work to reduce blood pressure overall and in the kidneys, help people to lose weight and improve their salt and water excretion, there are a number of good things about this class of drugs that would make it ideal for delaying the progression of kidney disease,” explains Dr. Adeera Levin, department head of the Division of Nephrology at the University of British Columbia, executive director of BC Renal and nephrologist at St. Paul’s Hospital in Vancouver.
Interested in the potential of SGLT2 inhibitors to benefit kidney patients, Levin partnered with an international collaboration of researchers to help co-lead the Canadian arm of the EMPA-KIDNEY trial. The randomized control study assessed the effects of a SGLT2 inhibitor, called empagliflozin, in a broad range of kidney patients. A total of 6,609 patients participated, with half receiving 10 mg of empagliflozin daily and the other half receiving a placebo daily.
The results, published earlier this year in the New England Journal of Medicine, showed that empagliflozin offers numerous benefits to kidney patients, regardless of whether or not they also have diabetes.
“In patients with kidney function as low as 20 ml/min at enrolment, empagliflozin was shown to delay kidney disease progression, and reduce risk of hospitalization for heart failure, time to dialysis and acute kidney injury,” says Levin, referring to the key measurement known as eGFR (estimated glomerular filtration rate).
Over an average of two years, the portion of patients who experienced progression of kidney disease or death from cardiovascular causes was lower in the empagliflozin group (13.1%) than the placebo group (16.9%), meaning many kidney patients across Canada could benefit greatly from treatment from this class of drug.
Levin notes that the results of this study are significant for people living with kidney disease. “It offers potential for better health outcomes to a large group of people who otherwise didn’t have any treatments available to delay their disease progression,” she says. “This study is truly a huge milestone for the kidney community.”