Chronic kidney disease (CKD) did not affect the efficacy or safety of empagliflozin for patients with heart failure with preserved ejection fraction (HFpEF) in the EMPEROR-Preserved trial. The study shows once again that agents in the sodium-glucose cotransporter 2 (SGLT2) inhibitor class can be used for patients with heart failure despite severely compromised kidney function.

Among around 6000 patients with heart failure and HFpEF included in EMPEROR-Preserved, over half of them had CKD, including 10% having an estimated glomerular filtration rate (eGFR) in the range of 20-29 mL/min/1.73m2 (stage 4 CKD). In a prespecified analysis, treatment with empagliflozin was associated with a consistent, significant relative risk reduction in the primary endpoint of cardiovascular death or hospitalization for heart failure across the full spectrum of kidney function, in comparison with placebo, stated Faiez Zannad, presenting the findings at the virtual Kidney Week 2021.

Among the 46.5% of patients without CKD, empagliflozin led to a significant 20% decline in the primary outcome in comparison with placebo. Among the 53.5% of patients who had CKD at the time of randomization, empagliflozin led to a significant 25% decline in the primary endpoint compared with placebo… (Medscape)