BACKGROUND: Hyperuricaemia and gout are common in chronic kidney disease (CKD). We aimed to assess the effects of sodium-glucose co-transporter-2 (SGLT2) inhibition on uric acid (urate) and gout in patients with CKD. METHODS: The EMPA-KIDNEY trial randomised 6609 patients with CKD to receive either empagliflozin 10 mg daily or matching placebo over a median of 2 years of follow-up. Serum uric acid was measured at randomisation then at 2 and 18 months of follow-up and the effects of empagliflozin were analysed using a pre-specified mixed model repeated measures approach. Participant-reported gout events were analysed in Cox regression models (first events) with the Andersen-Gill extension (total events). A post hoc composite outcome included new initiation of uric acid-lowering therapy or colchicine. EMPA-KIDNEY primary and kidney disease progression outcomes were also assessed in subgroups of baseline serum uric acid. RESULTS: Baseline mean ± standard deviation serum uric acid concentration was 431 ± 114 µmol/l. Allocation to empagliflozin resulted in a study-average between-group difference in serum uric acid of -25.6 µmol/l [95% confidence interval (CI) -30.3 to -21.0], with larger effects in those with higher eGFR (trend P
Journal article
Nephrol Dial Transplant
01/04/2025
40
720 - 730
CKD, SGLT2 inhibitor, empagliflozin, gout, uric acid, Humans, Glucosides, Benzhydryl Compounds, Uric Acid, Renal Insufficiency, Chronic, Male, Female, Middle Aged, Sodium-Glucose Transporter 2 Inhibitors, Aged, Double-Blind Method, Follow-Up Studies, Hyperuricemia, Glomerular Filtration Rate, Gout, Prognosis, Disease Progression