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. Author manuscript; available in PMC: 2020 Dec 15.
Published in final edited form as: Am J Cardiol. 2019 Dec 15;124(Suppl 1):S28–S35. doi: 10.1016/j.amjcard.2019.10.027

Figure 3.

Figure 3

Similarity of eGFR outcomes in SGLT2 inhibitor clinical trials of (A) empagliflozin (EMPA-REG OUTCOME)24 and (B) canagliflozin (CREDENCE)27 compared with (C) an earlier RAAS blocker (enalapril) trial.29 Patients destined to benefit from SGLT2 inhibitor or ACEI treatment show an immediate decline in eGFR, which remains stable thereafter, whereas eGFR continues to decline in the comparator group. (A) Adjusted means for the eGFR over a period of 192 weeks in the EMPA-REG OUTCOME trial.24 From New England Journal of Medicine, Wanner C, et al., Empagliflozin and progression of kidney disease in type 2 diabetes, 375, 323–334. Copyright © 2016 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society. (B) Change from the screening level in eGFR in the on-treatment population in the CREDENCE trial.27 The I bars indicate the standard error. From New England Journal of Medicine, Perkovic V, et al. for the CREDENCE Trial Investigators, Canagliflozin and renal outcomes in type 2 diabetes and nephropathy, 380, 2295–2306. Copyright © 2019 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society. (C) Time course of eGFR before, during, and after withdrawal of antihypertensive treatment: in group A (•), patients who initially showed a distinct fall in GFR, and in group B (°), patients in whom eGFR did not fall after start of treatment in the enalapril trial.23 This figure shows a rebound increase in eGFR on cessation of enalapril treatment; this rebound also occurs with cessation of treatment with SGLT2 inhibitors (data not shown). Reprinted from Kidney International, 51 (3), Apperloo AJ, et al., A short-term antihypertensive treatment-induced fall in glomerular filtration rate predicts long-term stability of renal function, 793–797, Copyright 1997, with permission from Elsevier and International Society of Nephrology. ACEI = angiotensin-converting enzyme inhibitor; eGFR = estimated glomerular filtration rate; Empa = empagliflozin; RAAS = renin-angiotensin-aldosterone system; SGLT2 = sodium-glucose co-transporter 2.