Does empaglifozin increase or decrease kidney disease in patients with type 2 diabetes?

This study looked at the effect of empaglifozin (Jardiance) on kidney disease progression in patients with type 2 diabetes (T2D). They found that empaglifozin was associated with a slower rate of kidney disease progression and reduced risk of development of kidney related disease. 

Empaglifozin is a drug which lowers blood glucose levels by increasing the amount of glucose leaving the body through the urine. There has been concern that empagliflozin and other treatments in the same family (such as Farxiga) may cause long term side effects to the kidney. T2D patients are already at increased risk, as 35% of patients will develop kidney disease. 

This study looked at the effect of empaglifozin on the kidneys.

7020 T2D patients with established cardiovascular (CV; heart and blood vessel) disease were assigned to receive empaglifozin or a placebo drug (substance with no effect on the body).

Patients receiving empaglifozin were 39% less likely to develop kidney disease or to experience worsening of existing kidney disease compared to those treated with placebo.

Empaglifozin reduced the risk of developing more advanced kidney disease, defined by presence of large protein in the urine, by 38%. Empaglifozin had no effect on development of microalbuminuria (small proteins in the urine).

Patients receiving empaglifozin were 55% less likely to require renal replacement (dialysis or kidney transplant).

Creatinine is a protein which should be filtered out of the blood by the kidneys but fails to be removed when kidneys are damaged. Patients receiving empaglifozin were 44% less likely to experience doubling of creatinine levels in the blood.

Initially treatment with empaglifozin was associated with a slight decrease in the filtering abilities of the kidneys. However, with long term treatment, no further decrease was observed. A steady decrease was seen in the placebo group.

Empaglifozin was, however, associated with increased risk of genital infections. 

This study concluded that treatment with empaglifozin in patients with T2D at high CV risk was associated with slower progression of kidney disease and decreased risk of development of kidney damage or disease. 

Results of this study cannot be applied to those at low CV risk.

The majority of patients in this study were Caucasion, Asian, or Hispanic. These results may not be generalized to African-Americans or those of African descent, due to the small number of participants included.

This study was funded by the pharmaceutical companies Boehringer Ingelheim and Eli Lily.