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EMPA-KIDNEY Low Albuminuria Subgroup — ESENeph MCQ

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ModerateChronic Kidney DiseaseEMPA-KIDNEY Low Albuminuria SubgroupESENeph

A 50-year-old man with CKD G4 and type 2 diabetes asks about the EMPA-KIDNEY subgroup that included patients with eGFR 20-45 and ACR <300 mg/g. What was the finding in this lower-albuminuria subgroup?

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Correct answer: B — EMPA-KIDNEY showed benefit in this broader population including those with eGFR 20-45 and lower albuminuria – supporting KDIGO 2024 suggestion (2B) to use SGLT2i in this group even without high-level albuminuria

EMPA-KIDNEY uniquely included patients with eGFR 20-45 regardless of albuminuria level (including ACR <300 mg/g). The overall trial was positive, and while the subgroup with lower albuminuria showed a consistent trend toward benefit, the confidence interval for this subgroup included the null. This led to the KDIGO 2024 weaker (2B suggestion vs 1A recommendation) for SGLT2i in eGFR 20-45 with ACR <200 mg/g. The clinical interpretation is that benefit likely exists but evidence certainty is lower than for highly albuminuric patients.

Reference: EMPA-KIDNEY – NEJM 2023; KDIGO 2024 – CKD