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EMPA-KIDNEY Collaborative Group et al. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023;388(2):117-127. PMID 36331190

One-paragraph summary

EMPA-KIDNEY randomized 6,609 people with eGFR 20–<45 regardless of albuminuria, or eGFR 45–<90 with uACR at least 200 mg/g, to empagliflozin 10 mg or placebo.

Key findings

  • Kidney progression or cardiovascular death: 13.1% versus 16.9%; HR 0.72 (95% CI 0.64–0.82). (EMPA-KIDNEY Collaborative Group 2023, PMID 36331190)
  • All-cause hospitalization: HR 0.86 (95% CI 0.78–0.95). (EMPA-KIDNEY Collaborative Group 2023, PMID 36331190)
  • Serious adverse-event rates were similar. (EMPA-KIDNEY Collaborative Group 2023, PMID 36331190)
  • The prespecified slope analysis found a 2.12 mL/min/1.73 m² acute dip (95% CI 1.83–2.41) and chronic slope −1.37 versus −2.75 per year (relative difference 50%, 95% CI 42–58). This result is in the 2024 secondary-analysis paper, not the primary report. (EMPA-KIDNEY Collaborative Group 2024, PMID 38061371)

Limitations

  • Median follow-up was 2.0 years.
  • Clinical-event precision is lower in slowly progressive low-albuminuria strata.
  • The primary composite combines kidney progression with cardiovascular death.

Why it matters

It broadened SGLT2 kidney evidence to lower GFR and lower albuminuria and supplied a clear acute-versus-chronic slope analysis.

Auditor note (2026-09-02)

The slope figures above were originally attributed to PMID 36331190; they belong to the prespecified secondary analysis, PMID 38061371. Corrected.

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