Empagliflozin versus dapagliflozin for kidney outcomes in stage 3 chronic kidney disease: a propensity score-matched multi-center cohort study

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2)-inhibitors are key in chronic kidney disease (CKD) management with empagliflozin and dapagliflozin being the two most commonly used. Comparative data between them in CKD is limited. METHODS: A propensity score-matched cohort study was conducted using data from a network of 103 North American organizations. Adults with Stage 3 CKD who initiated empagliflozin or dapagliflozin between January 1, 2021 and December 31, 2023, were compared. The primary outcome was the composite of Stage 5 CKD or end-stage kidney disease (ESKD). Follow-up continued until outcome or up to 3 years (censored on April 3, 2026). RESULTS: 53,887 and 27,344 patients with Stage 3 CKD were initiated on empagliflozin and dapagliflozin, respectively. Among matched patients with Stage 3 CKD (N = 26,911 per group) empagliflozin initiation was associated with lower risk of Stage 5 CKD or ESKD (7.7% vs. 9.0%; HR: 0.84; 95% CI: 0.79 to 0.89; log-rank P < 0.001) over ~ 970 days. All-cause mortality was similar between groups. Stage 5 CKD and ESKD rates were lower in the empagliflozin group. CONCLUSION: In this multi-center retrospective cohort study, the risk for Stage 5 CKD or ESKD was lower for patients with Stage 3 CKD who initiated empagliflozin versus dapagliflozin over ~ 2.5 years. Prospective studies are needed to confirm our findings.