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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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Ablikim M, Achasov MN, Adlarson P, Ahmed S, Albrecht M, Aliberti R, Amoroso A, An Q, Bai Y, Bakina O, Ferroli RB, Balossino I, Ban Y, Begzsuren K, Berger N, Bertani M, Bettoni D, Bianchi F, Bloms J, Bortone A, Boyko I, Briere RA, Cai H, Cai X, Calcaterra A, Cao GF, Cao N, Cetin SA, Chang JF, Chang WL, Chelkov G, Chen G, Chen HS, Chen ML, Chen SJ, Chen XR, Chen YB, Chen ZJ, Cheng WS, Cibinetto G, Cossio F, Dai HL, Dai JP, Dai XC, Dbeyssi A, de Boer RE, Dedovich D, Deng ZY, Denig A, Denysenko I, Destefanis M, De Mori F, Ding Y, Dong J, Dong LY, Dong MY, Dong X, Du SX, Fang J, Fang SS, Fang Y, Farinelli R, Fava L, Feldbauer F, Felici G, Feng CQ, Fritsch M, Fu CD, Gao YN, Gao Y, Gao Y, Garzia I, Gersabeck EM, Gilman A, Goetzen K, Gong L, Gong WX, Gradl W, Greco M, Gu LM, Gu MH, Gu S, Gu YT, Guan CY, Guo AQ, Guo LB, Guo RP, Guo YP, Guskov A, Han TT, Hao XQ, Harris FA, He KL, Heinsius FHH, Heinz CH, Heng YK, Herold C, Himmelreich M, Holtmann T, Hou YR, Hou ZL, Hu HM, Hu JF, Hu T, Hu Y, Huang GS, Huang LQ, Huang XT, Huang YP, Hussain T, Imoehl W, Irshad M, Jaeger S, Janchiv S, Ji Q, Ji QP, Ji XB, Ji XL, Jiang XS, Jiao JB, Jiao Z, Jin S, Jin Y, Johansson T, Kalantar-Nayestanaki N, Kang XS, Kappert R, Kavatsyuk M, Ke BC, Keshk IK, Khoukaz A, Kiese P, Kiuchi R, Kliemt R, Kolcu OB, Kopf B, Kuemmel M, Kuessner MK, Kupsc A, Kurth MG, Kühn W, Lane JJ, Larin P, Lavania A, Lavezzi L, Lei ZH, Leithoff H, Lellmann M, Lenz T, Li C, Li CH, Li C, Li DM, Li F, Li G, Li H, Li HB, Li HJ, Li JQ, Li JW, Li K, Li LK, Li L, Li PL, Li PR, Li SY, Li WD, Li WG, Li XH, Li XL, Li ZY, Liang H, Liang H, Liang H, Liang YF, Liang YT, Liao GR, Liao LZ, Libby J, Limphirat A, Liu BJ, Liu CX, Liu D, Liu FH, Liu F, Liu F, Liu HB, Liu HM, Liu H, Liu H, Liu JB, Liu JY, Liu K, Liu KY, Liu L, Liu MH, Liu Q, Liu SB, Liu S, Liu T, Liu WM, Liu X, Liu YB, Liu ZA, Liu ZQ, Lou XC, Lu FX, Lu HJ, Lu JD, Lu JG, Lu XL, Lu Y, Lu YP, Luo CL, Luo MX, Luo T, Luo XL, Lusso S, Lyu XR, Ma FC, Ma HL, Ma LL, Ma MM, Ma QM, Ma RQ, Ma RT, Ma XX, Ma XY, Maas FE, Maggiora M, Maldaner S, Malde S, Malik QA, Mangoni A, Mao YJ, Mao ZP, Marcello S, Meng ZX, Messchendorp JG, Mezzadri G, Min TJ, Mitchell RE, Mo XH, Muchnoi NY, Muramatsu H, Nakhoul S, Nefedov Y, Nerling F, Nikolaev IB, Ning Z, Nisar S, Olsen SL, Ouyang Q, Pacetti S, Pan X, Pan Y, Pathak A, Patteri P, Pelizaeus M, Peng HP, Peters K, Ping JL, Ping RG, Pitka A, Poling R, Prasad V, Qi H, Qi HR, Qi M, Qi TY, Qian S, Qian WB, Qiao CF, Qin LQ, Qin XP, Qin XS, Qin ZH, Qiu JF, Qu SQ, Qu SQ, Ravindran K, Redmer CF, Rivetti A, Rodin V, Rolo M, Rong G, Rosner C, Sarantsev A, Schelhaas Y, Schnier C, Schoenning K, Scodeggio M, Shan DC, Shan W, Shan XY, Shao M, Shen CP, Shen PX, Shen XY, Shi HC, Shi RS, Shi X, Shi XD, Song WM, Song YX, Sosio S, Spataro S, Su KX, Sun GX, Sun JF, Sun L, Sun SS, Sun T, Sun WY, Sun YJ, Sun YK, Sun YZ, Sun ZT, Tan YH, Tan YX, Tang CJ, Tang GY, Tang J, Teng JX, Thoren V, Uman I, Wang B, Wang BL, Wang CW, Wang DY, Wang HP, Wang K, Wang LL, Wang M, Wang M, Wang WH, Wang WP, Wang X, Wang XF, Wang XL, Wang Y, Wang YD, Wang YF, Wang YQ, Wang Z, Wang ZY, Wang Z, Wang Z, Wei DH, Weidenkaff P, Weidner F, Wen SP, White DJ, Wiedner UW, Wilkinson G, Wolke M, Wollenberg L, Wu JF, Wu LH, Wu LJ, Wu X, Wu Z, Xia L, Xiao H, Xiao SY, Xiao ZJ, Xie XH, Xie YG, Xie YH, Xing TY, Xu GF, Xu JJ, Xu QJ, Xu W, Xu XP, Xu YC, Yan F, Yan L, Yan WB, Yan WC, Yan X, Yang HJ, Yang HX, Yang L, Yang SL, Yang YH, Yang Y, Ye M, Ye MH, Yin JH, You ZY, Yu BX, Yu CX, Yu G, Yu JS, Yu T, Yuan CZ, Yuan L, Yuan W, Yuan Y, Yuan ZY, Yue CX, Zafar AA, Zeng Y, Zhang BX, Zhang GY, Zhang H, Zhang HH, Zhang HH, Zhang HY, Zhang JJ, Zhang JQ, Zhang JW, Zhang JY, Zhang JZ, Zhang J, Zhang J, Zhang L, Zhang SF, Zhang XD, Zhang XY, Zhang Y, Zhang YT, Zhang YH, Zhang Y, Zhang Y, Zhang ZY, Zhao G, Zhao J, Zhao JY, Zhao JZ, Zhao L, Zhao L, Zhao MG, Zhao Q, Zhao SJ, Zhao YB, Zhao YX, Zhao ZG, Zhemchugov A, Zheng B, Zheng JP, Zheng YH, Zhong B, Zhong C, Zhou LP, Zhou Q, Zhou X, Zhou XK, Zhou XR, Zhu AN, Zhu J, Zhu K, Zhu KJ, Zhu SH, Zhu WJ, Zhu WJ, Zhu YC, Zhu ZA, Zou BS, Zou JH. Search for Λ[over ¯]-Λ Baryon-Number-Violating Oscillations in the Decay J/ψ→pK^{-}Λ[over ¯]+c.c. PHYSICAL REVIEW LETTERS 2023; 131:121801. [PMID: 37802947 DOI: 10.1103/physrevlett.131.121801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023]
Abstract
We report on the first search for Λ[over ¯]-Λ oscillations in the decay J/ψ→pK^{-}Λ[over ¯]+c.c. by analyzing 1.31×10^{9} J/ψ events accumulated with the BESIII detector at the BEPCII collider. The J/ψ events are produced using e^{+}e^{-} collisions at a center of mass energy sqrt[s]=3.097 GeV. No evidence for hyperon oscillations is observed. The upper limit for the oscillation rate of Λ[over ¯] to Λ hyperons is determined to be P(Λ)=[B(J/ψ→pK^{-}Λ+c.c.)/B(J/ψ→pK^{-}Λ[over ¯]+c.c.)]<4.4×10^{-6} corresponding to an oscillation parameter δm_{ΛΛ[over ¯]} of less than 3.8×10^{-18} GeV at the 90% confidence level.
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