Most Read Articles
Pearl Toh, 22 Oct 2020
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Pearl Toh, 5 days ago
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Elvira Manzano, 17 Nov 2020
Invasive fungal infections, particularly those caused by Candida species, are common in hospitalized, immunocompromised, or critically ill patients and are associated with considerable morbidity and mortality.

eGFR dip does not influence outcomes in T2D patients on empagliflozin

Audrey Abella
17 Jun 2020

An eGFR* decline of >10 percent did not appear to influence kidney outcomes in individuals receiving empagliflozin for type 2 diabetes, according to data presented at ERA-EDTA 2020.

“[A]n initial eGFR dip … was consistently reported across the class of SGLT2** inhibitors … Although this is considered haemodynamic and largely reversible, this has raised concerns in clinical practice,” said Dr Bettina Kraus from the University Hospital Würzburg in Germany who presented the findings.

A post hoc analysis was conducted to weigh the implications of an initial eGFR dip and determine predictive baseline factors. Using data from EMPA-REG OUTCOME*** comparing empagliflozin 10 and 25 mg (n=4,443 [pooled]) against placebo (n=2,225), participants were classified according to eGFR declines from baseline to week 4: dippers (>10 percent), intermediate (≤10 percent), and nondippers (none, or with increased eGFR). [ERA-EDTA 2020, abstract LBCT 4547]

“We recognized that empagliflozin caused a shift towards more patients [being] categorized as eGFR dippers,” said Kraus. With placebo, 13 percent had experienced a >10-percent dip; this has more than doubled (28 percent) with empagliflozin.

Nonetheless, week 12 saw a “nice rebound”, said Kraus, followed by a consistent stabilization across all categories until 192 weeks. “Dippers returned to about 50 percent of the initial dip and regained some of the eGFR after 12 weeks … [T]hat was very reassuring.”

The rates of participants with a more pronounced eGFR decline (>30 percent) – which is regarded as alarming – were low (1.4 percent and 0.9 percent for empagliflozin and placebo, respectively). Kraus underscored however that this needs further exploration to determine other potential underlying causes for AKI#, volume depletion, etc.

Diuretic use and KDIGO## risk category were identified as predictive of an eGFR dip of >10 percent (odds ratios [ORs], 3.6, 4.7, and 4.4 for moderate, high, and very high risk groups, respectively). “[These suggest] that patients on diuretics and with at least moderately increased KDIGO risk are the ones most likely experiencing such a dip,” said Kraus.

The incidence of serious adverse events among empagliflozin recipients on diuretic therapy in the high and very high KDIGO risk category were 28.7 percent and 41.6 percent, respectively. Nonetheless, these were lower than placebo (36.5 and 45.5, respectively).

A reduction in incident or worsening nephropathy (hazard ratio [HR], 0.61) and hard kidney outcomes (HR, 0.54) was observed with empagliflozin vs placebo. A similar effect was seen in patients with increased dipping OR of >2.7 (HR, 0.56 and 0.70, respectively). The risk for nephropathy at week 4 was sustained irrespective of adjustments for eGFR dip (HR, 0.58), suggesting that such a dip did not influence the risk.

“[Taken together,] these data show that around one in four empagliflozin-treated patients experiences an initial eGFR dip. This was more likely in those taking diuretics and/or in more advanced stages of CKD###. [Nonetheless,] empagliflozin was safe and effective,” commented ERA-EDTA President-elect Professor Christoph Wanner from Würzburg, Germany. “For such high-risk patients … any intervention that slows the progression of kidney disease and allows the need for dialysis to be postponed as long as possible [is welcome].”

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 22 Oct 2020
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Pearl Toh, 5 days ago
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Elvira Manzano, 17 Nov 2020
Invasive fungal infections, particularly those caused by Candida species, are common in hospitalized, immunocompromised, or critically ill patients and are associated with considerable morbidity and mortality.