The kidneys maintain overall health by filtering waste and balancing fluids. When kidney function declines, it can lead to serious health complications. New therapeutic options are emerging to support kidney health and manage progressive kidney conditions, aiming to preserve function and improve patient outcomes.
How Empagliflozin Works for Kidneys
Empagliflozin is a medication in a class of drugs known as sodium-glucose co-transporter 2 (SGLT2) inhibitors. These inhibitors work in the kidneys, in the proximal tubules, which reabsorb most filtered glucose back into the bloodstream. By blocking SGLT2 proteins, empagliflozin reduces glucose reabsorption, leading to increased glucose excretion in the urine.
This mechanism lowers blood glucose, benefiting individuals with type 2 diabetes. Beyond its glucose-lowering effects, empagliflozin also impacts kidney function. It increases the excretion of sodium and water, contributing to a reduction in blood pressure and intravascular volume. This process helps alleviate pressure within the kidney’s filtering units, known as glomeruli, and may correct glomerular hyperfiltration, a condition where kidneys over-filter blood. These combined actions contribute to the medication’s protective effects on kidney health.
Who Can Benefit from Empagliflozin
Empagliflozin is indicated for individuals with chronic kidney disease (CKD). It has an established role in those diagnosed with CKD, including individuals with or without type 2 diabetes. The medication is also indicated for adults with heart failure, which often co-occurs with CKD and can contribute to kidney complications.
Clinical trials, such as EMPA-KIDNEY, demonstrated empagliflozin’s effectiveness across a wide range of patients at risk of CKD progression. These studies included individuals with various stages of CKD, with estimated glomerular filtration rates (eGFR) as low as 20 mL/min/1.73 m². Empagliflozin is a prescription medication, requiring consultation and ongoing monitoring by a healthcare professional to determine suitability and dosage.
The Impact on Kidney Health
Empagliflozin slows the progression of kidney disease. It reduces the risk of kidney failure and can potentially decrease the need for kidney-related interventions, such as dialysis or kidney transplantation. The medication helps preserve kidney function over time, as evidenced by a slower decline in the estimated glomerular filtration rate (eGFR). In clinical trials, empagliflozin consistently reduced the risk of a composite outcome of kidney disease progression or cardiovascular death.
In the EMPA-KIDNEY trial, empagliflozin reduced the risk of CKD progression or cardiovascular-related death by 28% compared to placebo over a median 2-year follow-up. The medication also led to a significant reduction in all-cause hospitalizations. These benefits were observed across a broad spectrum of patients, including those with and without diabetes, and across various levels of kidney function. Empagliflozin contributes to maintaining kidney function and reducing severe kidney-related events.
Navigating Empagliflozin: Side Effects and Safety
Common side effects include urinary tract infections (UTIs) and genital yeast infections, which occur due to increased glucose in the urine. Dehydration can occur, as the medication increases fluid excretion; maintaining adequate hydration is important. Patients may experience symptoms such as increased urination, thirst, or dizziness.
Less common but serious side effects can also occur. These include diabetic ketoacidosis, a serious condition where harmful substances called ketones build up in the body, which can happen even without high blood sugar. Rare but severe infections, such as necrotizing fasciitis of the perineum, also known as Fournier’s gangrene, have been reported. Patients should seek immediate medical attention if they experience severe pain, tenderness, redness, or swelling in the genital area, especially with fever or feeling unwell. Regular medical follow-ups are important for monitoring kidney function and managing any potential side effects.