Christoph Wanner, MD

Disclosures

November 01, 2016

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My name is Christoph Wanner. I'm a nephrologist at University Hospital Würzburg, Germany, and professor of medicine at the university. About 1 year ago, the prominent cardiovascular results of the EMPA-REG OUTCOME trial were published.[1] I was also involved in the evaluation of kidney outcomes in this trial, and those results were published a bit more than a month ago in the New England Journal of Medicine.[2]

By looking carefully at the data, we saw that the secondary composite outcomes of EMPA-REG OUTCOME were reduced by a similar magnitude as the primary outcomes. The microvascular kidney outcomes consisted of development or reduction in macroalbuminuria, doubling of serum creatinine, renal replacement therapy, or dialysis. The relative risk for this composite was reduced by 39% in patients receiving empagliflozin, which is a very prominent outcome for us in nephrology.

This could be translated as saying that we saved the patients about 5 mL/min/1.73 m2 estimated glomerular filtration rate (eGFR) over the study period. This 5 mL/min/1.73 m2 eGFR could also be translated as about 1-1.5 years free from renal replacement therapy or dialysis.

The results were initially surprising. It has been 15 years since we saw such a prominent risk reduction with renin-angiotensin system blockade and blood pressure control. Now, the next step is sodium-glucose cotransporter 2 (SGLT2) inhibition leading to elimination of glucose—about 80 g/day—from the body by the kidney. Removal of glucose, salt, and water results in positive effects on the heart and the circulatory system, and prominent reductions in cardiovascular and all-cause mortality.

By using these principles in the future, our patients will most likely, according to the trial results, have reduced negative cardiovascular and kidney outcomes. End-stage renal disease and dialysis will be pushed farther down the road.

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