Empaglifozin in Early Diabetic Kidney Disease

This is an interventional treatment trial for Diabetic Kidney Disease focused on measuring Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitor, Kidney Biopsy, Morphometry, American Indians, Glomerular Filtration Rate Read More

• INCLUSION CRITERIA:

To be eligible for participation in the study, participants must meet the following criteria:

• American Indian heritage participants must be at least half American Indian (i.e. 2 out of 4 grand-parents)
• Aged 18-64 years. The lower age limit was set so renal function test results would not reflect changes associated with growth and the upper limit was set to avoid the bladder emptying problems often encountered in older people, since complete bladder emptying is crucial to the accuracy of the renal function measurements done in this study.
• Diagnosis of type 2 diabetes for greater than or equal to 5 years.
• Estimated GFR >60/ml/min as determined from the CKD-EPI equation using serum creatinine (Levey et al., 2009) or serum creatinine concentration <1.4 mg/dl in women and <1.5 mg/dl in men.
• Serum potassium concentration less than or equal to 5.5 mEq/L.
• A screening urinary albumin-to-creatinine ratio <300 mg/g.
• Willingness to participate after receiving a thorough explanation of the study.
• Participants receiving a RAS blocker must have been receiving the drug for at least 3 months prior to the study baseline examination.

EXCLUSION CRITERIA:

Volunteers will be excluded prior to enrollment for the following reasons:

• Clinically significant disorders of the liver [cirrhosis, portal hypertension, hepatitis, increased bilirubin (greater than or equal to 1.5 mg/dl), cardiovascular disease (angina pectoris, history of myocardial infarction, heart failure, cerebrovascular disease, peripheral vascular disease, pulmonary diseases (asthma and restrictive or obstructive lung disease requiring therapy), renal-urinary disorders (calculi, urinary tract obstruction, glomerulonephritis, chronic infection), gastrointestinal disorders (nausea, vomiting, diarrhea or anorexia sufficient to cause weight loss or wasting), or hematocrit levels less than or equal to 30 percent or >55 percent in women or greater than or equal to 35 percent or >60 percent in men.
• Prior treatment with SGLT2 inhibitors.
• Renovascular or malignant hypertension; uncontrolled hypertension (systolic blood pressure greater than or equal to 160 or diastolic greater than or equal to 95 mm Hg) despite treatment with three antihypertensive drugs.
• Hematuria of unknown etiology. Prior to entry into the study, any participant with hematuria should be evaluated, the etiology established and documented, and treatment rendered as appropriate.
• Chronic debilitating disorders with or without treatment (e.g., systemic lupus erythematosus (SLE), cancer, amyloidosis, and chronic infection) that would interfere with the assessment of kidney function or that might reduce the chances of survival for a sufficient length of time to evaluate the efficacy of treatment.
• Currently receiving a drug regimen that includes: steroids, immunosuppressants, or investigational new drugs.
• Pregnancy. Boerhinger Ingelheim, the manufacturer of empagliflozin, do not recommend its use during the second or third trimester of pregnancy. Moreover, we do not wish to expose pregnant women to conscious sedation that is used during the kidney biopsies or to the intravenous filtration markers iothalamate and para-aminohippurate needed for the renal clearance studies. Women of childbearing potential must have a negative pregnancy test prior to entry and every 3 months during the study, and agree to using an effective form of contraception throughout the study, such as the oral contraceptive pill or an intrauterine device. Women who are planning a pregnancy in the next three years will be excluded.
• Symptoms of inability to empty the bladder. The urinary clearance method is only accurate if complete bladder emptying is possible.
• Hypersensitivity to empagliflozin or iodine.
• Bleeding disorders or requirements for anticoagulation or platelet inhibitors which cannot be safely interrupted, since kidney biopsies cannot be performed safely in these individuals.
• Massive obesity with body mass index greater than or equal to 45 kg/m(2). Kidney biopsies are more difficult and present greater hazards to people with massive obesity.
• Allergy to iodine-containing contrast material.
• Non-diabetic kidney disease based on clinical history or kidney biopsy examination.
• History of severe recurrent kidney infections.
• History of osteoporotic fracture.
• Conditions likely to interfere with informed consent or compliance with the protocol.