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Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Abe K, Akhlaq N, Akutsu R, Ali A, Alonso Monsalve S, Alt C, Andreopoulos C, Antonova M, Aoki S, Arihara T, Asada Y, Ashida Y, Atkin ET, Barbi M, Barker GJ, Barr G, Barrow D, Batkiewicz-Kwasniak M, Bench F, Berardi V, Berns L, Bhadra S, Blanchet A, Blondel A, Bolognesi S, Bonus T, Bordoni S, Boyd SB, Bravar A, Bronner C, Bron S, Bubak A, Buizza Avanzini M, Caballero JA, Calabria NF, Cao S, Carabadjac D, Carter AJ, Cartwright SL, Catanesi MG, Cervera A, Chakrani J, Cherdack D, Chong PS, Christodoulou G, Chvirova A, Cicerchia M, Coleman J, Collazuol G, Cook L, Cudd A, Dalmazzone C, Daret T, Davydov YI, De Roeck A, De Rosa G, Dealtry T, Delogu CC, Densham C, Dergacheva A, Di Lodovico F, Dolan S, Douqa D, Doyle TA, Drapier O, Dumarchez J, Dunne P, Dygnarowicz K, Eguchi A, Emery-Schrenk S, Erofeev G, Ershova A, Eurin G, Fedorova D, Fedotov S, Feltre M, Finch AJ, Fiorentini Aguirre GA, Fiorillo G, Fitton MD, Franco Patiño JM, Friend M, Fujii Y, Fukuda Y, Fusshoeller K, Giannessi L, Giganti C, Glagolev V, Gonin M, González Rosa J, Goodman EAG, Gorin A, Grassi M, Guigue M, Hadley DR, Haigh JT, Hamacher-Baumann P, Harris DA, Hartz M, Hasegawa T, Hassani S, Hastings NC, Hayato Y, Henaff D, Hiramoto A, Hogan M, Holeczek J, Holin A, Holvey T, Hong Van NT, Honjo T, Iacob F, Ichikawa AK, Ikeda M, Ishida T, Ishitsuka M, Israel HT, Iwamoto K, Izmaylov A, Izumi N, Jakkapu M, Jamieson B, Jenkins SJ, Jesús-Valls C, Jiang JJ, Jonsson P, Joshi S, Jung CK, Jurj PB, Kabirnezhad M, Kaboth AC, Kajita T, Kakuno H, Kameda J, Kasetti SP, Kataoka Y, Katayama Y, Katori T, Kawaue M, Kearns E, Khabibullin M, Khotjantsev A, Kikawa T, Kikutani H, King S, Kiseeva V, Kisiel J, Kobata T, Kobayashi H, Kobayashi T, Koch L, Kodama S, Konaka A, Kormos LL, Koshio Y, Kostin A, Koto T, Kowalik K, Kudenko Y, Kudo Y, Kuribayashi S, Kurjata R, Kutter T, Kuze M, La Commara M, Labarga L, Lachner K, Lagoda J, Lakshmi SM, Lamers James M, Lamoureux M, Langella A, Laporte JF, Last D, Latham N, Laveder M, Lavitola L, Lawe M, Lee Y, Lin C, Lin SK, Litchfield RP, Liu SL, Li W, Longhin A, Long KR, Lopez Moreno A, Ludovici L, Lu X, Lux T, Machado LN, Magaletti L, Mahn K, Malek M, Mandal M, Manly S, Marino AD, Marti-Magro L, Martin DGR, Martini M, Martin JF, Maruyama T, Matsubara T, Matveev V, Mauger C, Mavrokoridis K, Mazzucato E, McCauley N, McElwee J, McFarland KS, McGrew C, McKean J, Mefodiev A, Megias GD, Mehta P, Mellet L, Metelko C, Mezzetto M, Miller E, Minamino A, Mineev O, Mine S, Miura M, Molina Bueno L, Moriyama S, Moriyama S, Morrison P, Mueller TA, Munford D, Munteanu L, Nagai K, Nagai Y, Nakadaira T, Nakagiri K, Nakahata M, Nakajima Y, Nakamura A, Nakamura H, Nakamura K, Nakamura KD, Nakano Y, Nakayama S, Nakaya T, Nakayoshi K, Naseby CER, Ngoc TV, Nguyen VQ, Niewczas K, Nishimori S, Nishimura Y, Nishizaki K, Nosek T, Nova F, Novella P, Nugent JC, O’Keeffe HM, O’Sullivan L, Odagawa T, Ogawa T, Okada R, Okinaga W, Okumura K, Okusawa T, Ospina N, Owen RA, Oyama Y, Palladino V, Paolone V, Pari M, Parlone J, Parsa S, Pasternak J, Pavin M, Payne D, Penn GC, Pershey D, Pickering L, Pidcott C, Pintaudi G, Pistillo C, Popov B, Porwit K, Posiadala-Zezula M, Prabhu YS, Pupilli F, Quilain B, Radermacher T, Radicioni E, Radics B, Ramírez MA, Ratoff PN, Reh M, Riccio C, Rondio E, Roth S, Roy N, Rubbia A, Ruggeri AC, Ruggles CA, Rychter A, Sakashita K, Sánchez F, Santucci G, Schloesser CM, Scholberg K, Scott M, Seiya Y, Sekiguchi T, Sekiya H, Sgalaberna D, Shaikhiev A, Shaker F, Shaykina A, Shiozawa M, Shorrock W, Shvartsman A, Skrobova N, Skwarczynski K, Smyczek D, Smy M, Sobczyk JT, Sobel H, Soler FJP, Sonoda Y, Speers AJ, Spina R, Suslov IA, Suvorov S, Suzuki A, Suzuki SY, Suzuki Y, Sztuc AA, Tada M, Tairafune S, Takayasu S, Takeda A, Takeuchi Y, Takifuji K, Tanaka HK, Tanihara Y, Tani M, Teklu A, Tereshchenko VV, Teshima N, Thamm N, Thompson LF, Toki W, Touramanis C, Towstego T, Tsui KM, Tsukamoto T, Tzanov M, Uchida Y, Vagins M, Vargas D, Varghese M, Vasseur G, Vilela C, Villa E, Vinning WGS, Virginet U, Vladisavljevic T, Wachala T, Walsh JG, Wang Y, Wan L, Wark D, Wascko MO, Weber A, Wendell R, Wilking MJ, Wilkinson C, Wilson JR, Wood K, Wret C, Xia J, Xu YH, Yamamoto K, Yamamoto T, Yanagisawa C, Yang G, Yano T, Yasutome K, Yershov N, Yevarouskaya U, Yokoyama M, Yoshimoto Y, Yoshimura N, Yu M, Zaki R, Zalewska A, Zalipska J, Zaremba K, Zarnecki G, Zhao X, Zhu T, Ziembicki M, Zimmerman ED, Zito M, Zsoldos S. Measurements of neutrino oscillation parameters from the T2K experiment using 3.6×1021 protons on target. THE EUROPEAN PHYSICAL JOURNAL. C, PARTICLES AND FIELDS 2023; 83:782. [PMID: 37680254 PMCID: PMC10480298 DOI: 10.1140/epjc/s10052-023-11819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/10/2023] [Indexed: 09/09/2023]
Abstract
The T2K experiment presents new measurements of neutrino oscillation parameters using 19.7 ( 16.3 ) × 10 20 protons on target (POT) in (anti-)neutrino mode at the far detector (FD). Compared to the previous analysis, an additional 4.7 × 10 20 POT neutrino data was collected at the FD. Significant improvements were made to the analysis methodology, with the near-detector analysis introducing new selections and using more than double the data. Additionally, this is the first T2K oscillation analysis to use NA61/SHINE data on a replica of the T2K target to tune the neutrino flux model, and the neutrino interaction model was improved to include new nuclear effects and calculations. Frequentist and Bayesian analyses are presented, including results on sin 2 θ 13 and the impact of priors on the δ CP measurement. Both analyses prefer the normal mass ordering and upper octant of sin 2 θ 23 with a nearly maximally CP-violating phase. Assuming the normal ordering and using the constraint on sin 2 θ 13 from reactors, sin 2 θ 23 = 0 . 561 - 0.032 + 0.021 using Feldman-Cousins corrected intervals, and Δ m 32 2 = 2 . 494 - 0.058 + 0.041 × 10 - 3 eV 2 using constant Δ χ 2 intervals. The CP-violating phase is constrained to δ CP = - 1 . 97 - 0.70 + 0.97 using Feldman-Cousins corrected intervals, and δ CP = 0 , π is excluded at more than 90% confidence level. A Jarlskog invariant of zero is excluded at more than 2 σ credible level using a flat prior in δ CP , and just below 2 σ using a flat prior in sin δ CP . When the external constraint on sin 2 θ 13 is removed, sin 2 θ 13 = 28 . 0 - 6.5 + 2.8 × 10 - 3 , in agreement with measurements from reactor experiments. These results are consistent with previous T2K analyses.
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