Early changes in estimated glomerular filtration rate post-initiation of empagliflozin in EMPEROR-Preserved.

Autor: Rastogi T; Université de Lorraine, Inserm, Center d'Investigations Cliniques, - Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France., Ferreira JP; Université de Lorraine, Inserm, Center d'Investigations Cliniques, - Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.; Cardiovascular Research and Development Center, Department of Surgery and Physiologyeferences, Faculty of Medicine of the University of Porto, Porto, Portugal., Butler J; Baylor Scott and White Research Institute, TX and University of Mississippi, Jackson, MS, USA., Kraus BJ; Boehringer Ingelheim International GmbH, Ingelheim, Germany.; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.; Würzburg University Clinic, Würzburg, Germany., Mattheus M; Biostatistics, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany., Brueckmann M; Boehringer Ingelheim International GmbH, Ingelheim, Germany.; Vth Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany., Filippatos G; National and Kapodistrian University of Athens School of Medicine, Athens, Greece., Wanner C; Würzburg University Clinic, Würzburg, Germany., Pocock SJ; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK., Packer M; Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.; Imperial College, London, UK., Anker SD; Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies, German Center for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany., Zannad F; Université de Lorraine, Inserm, Center d'Investigations Cliniques, - Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2024 Apr; Vol. 26 (4), pp. 885-896. Date of Electronic Publication: 2024 Jan 21.
DOI: 10.1002/ejhf.3136
Abstrakt: Aims: Renal function (estimated glomerular filtration rate [eGFR]) changes early after the introduction of empagliflozin have not been described in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to describe early eGFR changes, assess its determinants and its clinical impact on cardiovascular and renal outcomes in patients with HFpEF enrolled in EMPEROR-Preserved.
Methods and Results: Estimated glomerular filtration rate changes (absolute and relative) from randomization to week 4 were calculated and landmark analyses performed. Initial eGFR change was available in 5836 patients (97.5% of the population). Empagliflozin induced a mean eGFR change of -3.2 ml/min/1.73 m 2 versus placebo from baseline to week 4. After week 4, in the empagliflozin group, the risk of the primary outcome (composite of heart failure hospitalization or cardiovascular death), cardiovascular, all-cause mortality and sustained ≥50% eGFR decrease or end-stage renal disease (ESRD) did not differ by eGFR change levels. In contrast, in the placebo group, patients included in the tertile with most profound eGFR decrease (i.e. ≥5.1% from baseline) had a higher risk of the primary outcome (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.17-1.82), cardiovascular mortality (HR 1.38, 95% CI 1.01-1.89) and sustained ≥50% eGFR decrease or ESRD (HR 2.20, 95% CI 1.20-4.04) versus tertile with eGFR increase.
Conclusion: An initial relatively small eGFR decrease may be expected after empagliflozin initiation. Such small eGFR decrease was not associated with adverse cardiovascular outcomes with empagliflozin. In contrast, eGFR decrease was associated with poor cardiovascular outcomes with placebo.
(© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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