EMPEROR-Reduced: Empagliflozin and Outcomes in Heart Failure and CKD

Background: In EMPEROR-Reduced, empagliflozin reduced cardiovascular death and heart failure hospitalizations and slowed the progressive decline in kidney function in heart failure and a reduced ejection fraction (HFrEF), with or without diabetes. We explored the effect of empagliflozin on cardiovascular and kidney outcomes, across the spectrum of kidney function. Methods: 3730 patients were randomized, of whom 1978 (53%) had prevalent chronic kidney disease (CKD) (eGFR<60ml/min/1.73m2 or an UACR>300mg/g). The key outcomes were (1) a composite of cardiovascular death or hospitalization for heart failure; (2) total hospitalizations for heart failure, and (3) eGFR slope; the last was supported by a prespecified composite renal outcome (defined as a profound sustained decline in eGFR, chronic dialysis or transplant). The median follow-up was 16 months. Results: Patients with prevalent CKD had a higher rate of CV and kidney events. Empagliflozin reduced the risk of cardiovascular death and hospitalization for heart failure by 25% (P< 0.001), reduced total hospitalizations for heart failure by 30% (P<0.001) and reduced the composite of chronic dialysis, transplant and renal death by 50% (P<0.01). All three benefits were seen consistently in patients with and without CKD (figure) and were apparent even in patients with severe impairment (eGFR from 20 to 30ml/min/1.73m2). Empagliflozin significantly slowed the yearly loss of eGFR and was well tolerated regardless of the level of baseline kidney function. Conclusions: In patients with HFrEF, empagliflozin reduced serious heart failure and serious adverse kidney outcomes, and slowed the decline in kidney function, regardless of the presence or absence of CKD and across a broad spectrum of baseline kidney function.Clinical outcomes in patients with HFrEF with and without prevalent kidney disease at baseline from EMPEROR-Reduced