Nephrology · 2 h ago
Empagliflozin increased kidney volume in small ADPKD trial
In a 50-participant randomized pilot trial, adults with autosomal dominant polycystic kidney disease (ADPKD) received empagliflozin or placebo for 12 months. Empagliflozin was generally tolerated, but kidney volume increased more in the treatment group; chronic eGFR change did not differ significantly between groups.
- Randomized 12-month pilot enrolled 50 adults with ADPKD.
- Kidney volume grew faster with empagliflozin than placebo.
- Chronic eGFR change did not differ significantly.
- Longer, larger studies are needed to assess clinical effects.
Sodium-glucose cotransporter 2 inhibitors benefit some patients with kidney disease, but their safety and efficacy in ADPKD are uncertain. In this pilot randomized trial, 50 adults aged 18–55 years with ADPKD and high risk of progression, not taking tolvaptan, received empagliflozin 25 mg once daily or placebo for 12 months. Safety and tolerability were the primary outcomes; kidney volume and eGFR changes were among the secondary outcomes.
Adverse-event frequency was similar between groups, and 96% in each group tolerated the full dose. Height-adjusted total kidney volume increased by 10.5% per year with empagliflozin (95% CI, 8.2%–12.7%) versus 5.1% with placebo (95% CI, 3.0%–7.3%; P=0.001). eGFR declined more at one month with empagliflozin, but chronic eGFR change from months 1 to 12 did not differ significantly (P=0.4). Changes in vascular stiffness, copeptin, kidney injury molecule-1, and patient-reported outcomes were also similar.
The findings raise concern about increased kidney-volume growth but do not establish effects on long-term kidney function. This small, 12-month pilot trial was not designed to determine clinical efficacy; larger and longer studies are needed before drawing conclusions about empagliflozin use in ADPKD.
In practice
For adults with ADPKD at high risk of progression who were not taking tolvaptan, this small randomized pilot found that empagliflozin was generally tolerated over 12 months but was associated with greater kidney-volume growth than placebo. The trial did not show a significant difference in chronic eGFR change and was not designed to establish long-term clinical benefit or harm. These preliminary results do not support changing treatment practice; applicability beyond the studied population and duration is uncertain.
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Journal of the American Society of Nephrology: Empagliflozin Therapy in Autosomal Dominant Polycystic Kidney Disease ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.