"So, hi, I'm Natalie Staplin from the University of Oxford and today, I'm going to be talking about the impact of acute eGFR dip on the effect of empagliflozin on acute kidney outcomes.

This meta analysis has used individual participant data from four large trials of empagliflozin, including patients with diabetes, heart failure and chronic kidney disease. And the importance of having individual participant data is that it's allowed us to create a prediction model for the size of acute eGFR dip. This means that we can do analyses looking at the effect of empagliflozin on acute kidney outcomes by the level of predicted acute eGFR dip. And these are analyses that are randomised, which isn't something that's been able to have been done in previous analyses using acute eGFR dip.

Sure. So overall we found that allocation to empagliplozin reduced 50% increases in serum creatinine taken in consecutive blood samples by 20% and also reduced the risk of acute kidney injury adverse events by about a quarter. And there was no evidence that that treatment effect was in any way modified by the level of predicted acute eGFR dip, meaning those with the largest dips have the same treatment effect as those with the smallest dips.

So as I mentioned previously, previous analyses have done some work looking at acute eGFR dips, but they've mostly only been able to look at the association of acute eGFR dips with outcomes separately by treatment allocation rather than doing randomised comparisons. So that's really the key strength of this meta analysis.

Based on these results and also previous studies that have shown that the acute eGFR dips are reversible when discontinuing treatment, the key take home messages cease to be that the acute eGFR dips are a benign phenomenon, and not then seem to be associated with any risk of harm. So it's really important for clinicians to maintain adherence to SGLT2 inhibitors for those participants who are at particularly high risk of acute kidney outcomes.

So for this research, ideally he would have liked to have individual participant data from all of the SGLT2 inhibitor trials rather than just those of empagliflozin. So that would be something that we would be interested in, expanded to in the future. Also, while we did develop a prediction model for acute eGFR dips that was only really to allow these subgroup analyses to be conducted so it's not externally validated and be able to be used to predict the types of patients who are going to have the largest acute dip. So that's also something that could be expanded in future research.”