Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial
<p><strong>Background:</strong> Sodium-glucose co-transporter-2 (SGLT2) inhibitors are recommended treatment for adults with chronic kidney disease (CKD), but uncertainty exists regarding their use in patients with frailty and/or multimorbidity, among whom polypharmacy is common. W...
| Main Authors: | , , , , , , , , , , , , |
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| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
American Society of Nephrology
2024
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| _version_ | 1811140286008524800 |
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| author | Mayne, KM Sardell, R Staplin, N Judge, P Zhu, D Sammons, E Wanner, C Emberson, J Preiss, D Landray, M Baigent, C Haynes, R Herrington, W |
| author2 | EMPA-KIDNEY Collaborative Group |
| author_facet | EMPA-KIDNEY Collaborative Group Mayne, KM Sardell, R Staplin, N Judge, P Zhu, D Sammons, E Wanner, C Emberson, J Preiss, D Landray, M Baigent, C Haynes, R Herrington, W |
| author_sort | Mayne, KM |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Sodium-glucose co-transporter-2 (SGLT2) inhibitors are
recommended treatment for adults with chronic kidney disease (CKD), but
uncertainty exists regarding their use in patients with frailty and/or multimorbidity,
among whom polypharmacy is common. We derived a multivariable logistic
regression model to predict hospitalization (reflecting frailty) and assessed
empagliflozin’s risk-benefit profile in a post-hoc analysis of the double-blind, placebocontrolled EMPA-KIDNEY trial.</p>
<br>
<p><strong>Methods:</strong> The EMPA-KIDNEY trial randomized 6609 patients with CKD (estimated
glomerular filtration rate [eGFR] ≥20<45 mL/min/1.73m2 , or ≥45<90 mL/min/1.73m2 with urinary albumin-to-creatinine ratio ≥200 mg/g) to receive either empagliflozin 10 mg daily or matching placebo and followed for two years (median). Additional characteristics analysed in subgroups were multimorbidity, polypharmacy and
health-related quality of life (HRQoL) at baseline. Cox regression analyses were performed with subgroups defined by approximate thirds of each variable.</p>
<br>
<p><strong>Results:</strong> The strongest predictors of hospitalization were N-terminal prohormone of
brain natriuretic peptide, poor mobility and diabetes; then eGFR and other comorbidities. Empagliflozin was generally well-tolerated independent of predicted risk of hospitalization. In relative terms, allocation to empagliflozin reduced the risk of the primary outcome of kidney disease progression or cardiovascular death by 28%
(hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.64-0.82); and all-cause hospitalization by 14% (HR 0.86, 95% CI 0.78-0.95); with broadly consistent effects across subgroups of predicted risk of hospitalization, multimorbidity, polypharmacy or HRQoL. In absolute terms, the estimated benefits of empagliflozin were greater in
those at highest predicted risk of hospitalization (reflecting frailty) and outweighed potential serious harms.</p>
<br>
<p><strong>Conclusions:</strong> These findings support the use of SGLT2 inhibitors in CKD, irrespective of frailty, multimorbidity or polypharmacy.</p> |
| first_indexed | 2024-09-25T04:19:34Z |
| format | Journal article |
| id | oxford-uuid:ddda34fa-8d93-4774-860c-01ac8287e9f6 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:19:34Z |
| publishDate | 2024 |
| publisher | American Society of Nephrology |
| record_format | dspace |
| spelling | oxford-uuid:ddda34fa-8d93-4774-860c-01ac8287e9f62024-07-25T10:06:00ZFrailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:ddda34fa-8d93-4774-860c-01ac8287e9f6EnglishSymplectic ElementsAmerican Society of Nephrology2024Mayne, KMSardell, RStaplin, NJudge, PZhu, DSammons, EWanner, CEmberson, JPreiss, DLandray, MBaigent, CHaynes, RHerrington, WEMPA-KIDNEY Collaborative Group<p><strong>Background:</strong> Sodium-glucose co-transporter-2 (SGLT2) inhibitors are recommended treatment for adults with chronic kidney disease (CKD), but uncertainty exists regarding their use in patients with frailty and/or multimorbidity, among whom polypharmacy is common. We derived a multivariable logistic regression model to predict hospitalization (reflecting frailty) and assessed empagliflozin’s risk-benefit profile in a post-hoc analysis of the double-blind, placebocontrolled EMPA-KIDNEY trial.</p> <br> <p><strong>Methods:</strong> The EMPA-KIDNEY trial randomized 6609 patients with CKD (estimated glomerular filtration rate [eGFR] ≥20<45 mL/min/1.73m2 , or ≥45<90 mL/min/1.73m2 with urinary albumin-to-creatinine ratio ≥200 mg/g) to receive either empagliflozin 10 mg daily or matching placebo and followed for two years (median). Additional characteristics analysed in subgroups were multimorbidity, polypharmacy and health-related quality of life (HRQoL) at baseline. Cox regression analyses were performed with subgroups defined by approximate thirds of each variable.</p> <br> <p><strong>Results:</strong> The strongest predictors of hospitalization were N-terminal prohormone of brain natriuretic peptide, poor mobility and diabetes; then eGFR and other comorbidities. Empagliflozin was generally well-tolerated independent of predicted risk of hospitalization. In relative terms, allocation to empagliflozin reduced the risk of the primary outcome of kidney disease progression or cardiovascular death by 28% (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.64-0.82); and all-cause hospitalization by 14% (HR 0.86, 95% CI 0.78-0.95); with broadly consistent effects across subgroups of predicted risk of hospitalization, multimorbidity, polypharmacy or HRQoL. In absolute terms, the estimated benefits of empagliflozin were greater in those at highest predicted risk of hospitalization (reflecting frailty) and outweighed potential serious harms.</p> <br> <p><strong>Conclusions:</strong> These findings support the use of SGLT2 inhibitors in CKD, irrespective of frailty, multimorbidity or polypharmacy.</p> |
| spellingShingle | Mayne, KM Sardell, R Staplin, N Judge, P Zhu, D Sammons, E Wanner, C Emberson, J Preiss, D Landray, M Baigent, C Haynes, R Herrington, W Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial |
| title | Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial |
| title_full | Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial |
| title_fullStr | Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial |
| title_full_unstemmed | Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial |
| title_short | Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial |
| title_sort | frailty multimorbidity and polypharmacy exploratory analyses of the effects of empagliflozin from the empa kidney trial |
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