Kidney function decline, heart failure hospitalization, and the effect of empagliflozin in heart failure: an EMPEROR-pooled analysis
Abstract
Background Kidney function decline in heart failure (HF) may accelerate during periods surrounding HF-related events, while sodium-glucose cotransporter 2 inhibitors slow kidney function decline. However, the temporal relationship between kidney function changes, HF-related events, and treatment effects has not been well characterized. Aims We aimed to explore kidney function trajectories around HF-related events and to assess whether empagliflozin modifies these changes. Methods and results In a pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials, we examined longitudinal changes in estimated glomerular filtration rate (eGFR) before and after HF-related events, defined as HF hospitalization or HF-related death. In the EMPEROR-Pooled analysis, HF-related events occurred in 12.7% of 9554 patients during a median follow-up of 20.9 months (14.7–28.6). Patients who experienced HF-related events had a steeper eGFR decline during the 12 months before the event than those without HF-related events: average −5.01 ml/min/1.73 m2/year vs −1.93 ml/min/1.73 m2/year; P < .001. During the 12 months after HF-related events, eGFR decline persisted at an average rate of −4.73 ml/min/1.73 m2/year. These trajectories were not materially altered after adjustment for concurrent NYHA class or natriuretic peptide levels. Compared with placebo, empagliflozin slowed eGFR decline in patients without events (between-group difference, 0.94 ml/min/1.73 m2/year) and before events (1.09 ml/min/1.73 m2/year). The post-event difference was smaller (0.29 ml/min/1.73 m2/year), without significant heterogeneity across periods (P > .10). Findings were consistent across trials and irrespective of prior HF hospitalization. Conclusion Across the LVEF spectrum, kidney function decline accelerated before HF-related events and remained rapid thereafter. Empagliflozin attenuated eGFR decline without evidence of heterogeneity across periods.
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BibTeX
@article{kobayashi2026kidney,
title = {{Kidney function decline, heart failure hospitalization, and the effect of empagliflozin in heart failure: an EMPEROR-pooled analysis}},
author = {Masatake Kobayashi and Kévin Duarte and Guillaume Baudry and João Pedro Ferreira and Luca Monzo and Javed Butler and Faiez Zannad and Nicolas Girerd},
journal = {European Journal of Heart Failure},
year = {2026},
month = oct,
doi = {10.1093/ejhf/xuag295},
url = {https://hal.univ-lorraine.fr/hal-05789113v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Kidney function decline, heart failure hospitalization, and the effect of empagliflozin in heart failure: an EMPEROR-pooled analysis
AU - Masatake Kobayashi
AU - Kévin Duarte
AU - Guillaume Baudry
AU - João Pedro Ferreira
AU - Luca Monzo
AU - Javed Butler
AU - Faiez Zannad
AU - Nicolas Girerd
PY - 2026
DA - 2026/10/06
JO - European Journal of Heart Failure
DO - 10.1093/ejhf/xuag295
UR - https://hal.univ-lorraine.fr/hal-05789113v1
AB - Background Kidney function decline in heart failure (HF) may accelerate during periods surrounding HF-related events, while sodium-glucose cotransporter 2 inhibitors slow kidney function decline. However, the temporal relationship between kidney function changes, HF-related events, and treatment effects has not been well characterized. Aims We aimed to explore kidney function trajectories around HF-related events and to assess whether empagliflozin modifies these changes. Methods and results In a pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials, we examined longitudinal changes in estimated glomerular filtration rate (eGFR) before and after HF-related events, defined as HF hospitalization or HF-related death. In the EMPEROR-Pooled analysis, HF-related events occurred in 12.7% of 9554 patients during a median follow-up of 20.9 months (14.7–28.6). Patients who experienced HF-related events had a steeper eGFR decline during the 12 months before the event than those without HF-related events: average −5.01 ml/min/1.73 m2/year vs −1.93 ml/min/1.73 m2/year; P < .001. During the 12 months after HF-related events, eGFR decline persisted at an average rate of −4.73 ml/min/1.73 m2/year. These trajectories were not materially altered after adjustment for concurrent NYHA class or natriuretic peptide levels. Compared with placebo, empagliflozin slowed eGFR decline in patients without events (between-group difference, 0.94 ml/min/1.73 m2/year) and before events (1.09 ml/min/1.73 m2/year). The post-event difference was smaller (0.29 ml/min/1.73 m2/year), without significant heterogeneity across periods (P > .10). Findings were consistent across trials and irrespective of prior HF hospitalization. Conclusion Across the LVEF spectrum, kidney function decline accelerated before HF-related events and remained rapid thereafter. Empagliflozin attenuated eGFR decline without evidence of heterogeneity across periods.
SN - 1388-9842
ER -