Empagliflozin for Kidney Transplant Complications

(CREST-KT Trial)

Overseen by Myles Wolf, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Duke University

Must be taking: Immunosuppressants

Must not be taking: SGLT2i, Anticoagulants

Disqualifiers: Type I diabetes, Other transplants, others

No Placebo Group

Prior Safety Data

Approved in 4 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing a medication called empagliflozin, which helps lower blood sugar, in kidney transplant patients. The study includes patients with and without type 2 diabetes to see if the medication can improve their health. Empagliflozin works by helping the kidneys remove extra sugar from the blood through urine. This medication has been shown to significantly reduce blood glucose levels and is well tolerated in patients with type 2 diabetes.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot be using SGLT2 inhibitors (a type of diabetes medication) or active anticoagulants (blood thinners) other than low-dose aspirin.

What data supports the effectiveness of the drug Empagliflozin for kidney transplant complications?

Empagliflozin has been shown to reduce the progression of chronic kidney disease and lower the risk of cardiovascular issues in patients with type 2 diabetes and kidney disease. This suggests it may help with kidney-related complications, although specific data for kidney transplant complications is not provided. ^{1 2 3 4 5}

Is empagliflozin safe for humans?

Empagliflozin (Jardiance) is generally well-tolerated and has been approved for use in conditions like heart failure and type 2 diabetes. However, it can have side effects, and patients should be monitored for issues like fluid deficits, especially if they have chronic kidney disease. ^{1 3 6 7 8}

How is the drug empagliflozin unique for kidney transplant complications?

Empagliflozin is unique because it is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that not only helps manage blood sugar levels but also offers heart and kidney protection, which is beneficial for patients with chronic kidney disease and cardiovascular issues. This dual role makes it different from other treatments that may not provide these additional protective benefits. ^{1 2 3 6 9}

Research Team

Myles Wolf, MD

Principal Investigator

Duke University

Eligibility Criteria

This trial is for kidney transplant recipients, with or without type 2 diabetes, who are 12-60 months post-transplant. They must be on standard immunosuppression and have a stable kidney function (eGFR ≥30). Excluded are those with recent severe rejection episodes, pregnant/nursing women, uncircumcised men, active heavy anticoagulant users, Type I diabetics, multiple organ transplants or high hemoglobin A1c levels.

Inclusion Criteria

It has been 1 to 5 years since my kidney transplant.

My kidney function, measured by eGFR, is at least 30ml/min/1.73m^2.

Able to provide written consent

Exclusion Criteria

I have had a solid organ transplant.

I have had more than 2 UTIs in the last year.

I am currently taking SGLT2 inhibitors.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Baseline

Baseline visit including renal biopsy and 3D echocardiogram

1 week

1 visit (in-person)

Treatment

Participants receive empagliflozin or placebo with follow-up visits every 3 months

18 months

6 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Dapagliflozin (SGLT2 Inhibitor)
• Empagliflozin (SGLT2 Inhibitor)
• Placebo (Drug)

Trial Overview The CREST-KT study tests the effects of Empagliflozin (a diabetes medication) in kidney transplant patients. It's a double-blind trial where participants are randomly assigned to receive either Empagliflozin or a placebo. The ratio of drug to placebo is 2:1 among both diabetic and non-diabetic groups.

Participant Groups

Group I: Arm I: With Type II Diabetes Active Control 2 Interventions

Kidney Transplant recipient with Type II diabetes, randomized to either Empagliflozin or a placebo.

Group II: Arm 2: Without Diabetes Active Control 2 Interventions

Kidney Transplant recipient without Type II diabetes, randomized to either Empagliflozin or a placebo

Empagliflozin is already approved in Canada, Japan for the following indications:

Approved in Canada as Jardiance for:

• Type 2 diabetes mellitus
• Heart failure with reduced ejection fraction
• Chronic kidney disease

Approved in Japan as Jardiance for:

• Type 2 diabetes mellitus
• Heart failure with reduced ejection fraction

Who Is Running the Clinical Trial?

Duke University

Lead Sponsor

Trials

2,495

Recruited

5,912,000+

Mary E. Klotman

Duke University

Chief Executive Officer since 2017

MD from Duke University School of Medicine

Michelle McMurry-Heath

Duke University

Chief Medical Officer since 2020

MD from Duke University School of Medicine

Findings from Research

The EMPA-KIDNEY study evaluated the effects of empagliflozin in patients with chronic kidney disease, demonstrating significant benefits in slowing the progression of kidney disease.

This study involved a large cohort of patients, providing robust evidence for the efficacy of empagliflozin as a treatment option for chronic kidney disease, highlighting its potential to improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

In CKD, once-daily empagliflozin reduced progression of kidney disease or CV death at 2 y. Kwong, YD., Hsu, CY.[2023]

In a study of 7020 patients with type 2 diabetes and chronic kidney disease, empagliflozin significantly reduced the risk of cardiovascular death by 29% and all-cause mortality by 24% compared to placebo.

Empagliflozin also decreased the risk of hospitalization for heart failure by 39% and all-cause hospitalization by 19%, demonstrating its efficacy in improving clinical outcomes for patients with both diabetes and kidney disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Empagliflozin and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus, Established Cardiovascular Disease, and Chronic Kidney Disease. Wanner, C., Lachin, JM., Inzucchi, SE., et al.[2022]

Empagliflozin (Jardiance®) is an effective treatment for type 2 diabetes (T2D) that works by inhibiting the sodium glucose cotransporter-2 (SGLT2), and it also offers cardioprotective and renoprotective benefits, making it particularly suitable for patients with cardiovascular disease (CVD) and chronic kidney disease (CKD).

While empagliflozin is generally well-tolerated and easy to administer, it does have some side effects and contraindications that need to be considered, highlighting the importance of evaluating its benefits against potential risks in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The dual role of empagliflozin: Cardio renal protection in T2DM patients. Shafiq, A., Mahboob, E., Samad, MA., et al.[2022]

In the EMPA-KIDNEY trial involving 6609 participants, empagliflozin significantly slowed the progression of chronic kidney disease, reducing the chronic decline in kidney function by 50% after an initial dip in eGFR.

The benefits of empagliflozin were observed across various patient groups, indicating that albuminuria levels should not be the sole factor in deciding treatment with SGLT2 inhibitors, as even patients with low albuminuria experienced significant improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. [2023]

Empagliflozin (Jardiance) is now approved for reducing the risk of cardiovascular death and hospitalization in adults with heart failure, even in those without diabetes, highlighting its expanded therapeutic use.

Healthcare providers, including nurses and nurse practitioners, should closely monitor patients for potential adverse effects, particularly fluid deficits, to ensure patient safety during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diabetes Drug Now Approved for Heart Failure. Aschenbrenner, DS.[2023]

In a study of 213 patients with type 2 diabetes and chronic kidney disease, urinary tract infections and genital mycotic infections were the most common adverse events associated with SGLT2 inhibitors, occurring at rates of 62.1 and 58.0 events per 1000 person-years, respectively.

Despite these adverse events, SGLT2 inhibitors led to favorable changes in kidney function markers, with significant decreases in urine albumin-to-creatinine ratios and hemoglobin A1c percentages, indicating their efficacy in managing diabetic kidney disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse Events of Sodium-Glucose Cotransporter-2 Inhibitors in Chronic Kidney Disease: A Retrospective Chart Review. Choi, H., Nguyen, LA., Wan, J., et al.[2022]

Empagliflozin, when administered to 15,081 patients with type 2 diabetes and moderate to severe chronic kidney disease (CKD), showed no new safety concerns, with similar rates of serious adverse events compared to placebo.

The treatment was associated with significantly lower risks of hyperkalemia and edema, suggesting potential benefits for patients with advanced CKD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety of Empagliflozin in Patients With Type 2 Diabetes and Chronic Kidney Disease: Pooled Analysis of Placebo-Controlled Clinical Trials. Tuttle, KR., Levin, A., Nangaku, M., et al.[2022]

Empagliflozin (Jardiance) has been associated with a significant reduction in cardiovascular mortality among patients with type 2 diabetes and established cardiovascular disease, although the exact mechanism for this benefit is not yet understood.

There is uncertainty regarding whether empagliflozin may also increase the risk of fractures, a concern raised with another SGLT2 inhibitor, canagliflozin (Invokana), and all SGLT2 inhibitors are noted to have only modest effectiveness in managing diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SGLT2 inhibitors: new reports. [2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

In CKD, once-daily empagliflozin reduced progression of kidney disease or CV death at 2 y. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Empagliflozin and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus, Established Cardiovascular Disease, and Chronic Kidney Disease. [2022]

3. England pubmed.ncbi.nlm.nih.gov

The dual role of empagliflozin: Cardio renal protection in T2DM patients. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. [2023]

5. Belgium pubmed.ncbi.nlm.nih.gov

[EMPAGLIFLOZIN (JARDIANCE) :Nw SGLT2 COTRANSPORTER INHIBITOR FOR TREATING TYPE 2 DIABETES]. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Diabetes Drug Now Approved for Heart Failure. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Adverse Events of Sodium-Glucose Cotransporter-2 Inhibitors in Chronic Kidney Disease: A Retrospective Chart Review. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Safety of Empagliflozin in Patients With Type 2 Diabetes and Chronic Kidney Disease: Pooled Analysis of Placebo-Controlled Clinical Trials. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

SGLT2 inhibitors: new reports. [2019]