Effects of the SGLT2 Inhibitor Empagliflozin in Patients With Euvolemic and Hypervolemic Hyponatremia (EMPOWER)

September 18, 2026 updated by: University Hospital, Basel, Switzerland

Effects of the SGLT2 Inhibitor Empagliflozin in Patients With Euvolemic and Hypervolemic Hyponatremia - a Multicentric Randomized Double-blind Placebo-controlled Trial (the EMPOWER Study)

Hyponatremia is the most common electrolyte derangement occurring in hospitalized patients. It is usually classified as hypovolemic, euvolemic or hypervolemic. The most common aetiology of euvolemic hyponatremia is the syndrome of inappropriate antidiuresis (SIAD). Hypervolemic hyponatremia is common in patients with congestive heart failure (CHF) (10-27%) and liver cirrhosis (up to approximately 50%). In SIAD, the regulation of arginine vasopressin (AVP) secretion is impaired which leads to free water retention. In CHF and liver cirrhosis, the effective arterial blood volume is decreased leading to non-osmotic baroreceptor mediated AVP release and consecutive free water retention.

Current treatments of euvolemic and hypervolemic hyponatremia, including the most used treatment fluid restriction, are of limited efficacy. Sodium-Glucose-Co-Transporter 2 (SGLT2) inhibitors reduce glucose reabsorption in the proximal tubule, resulting in glucosuria and consecutive osmotic diuresis. A placebo-controlled randomized trial of our group has shown that a short-term, i.e. a 4-days administration of the SGLT2 inhibitor empagliflozin (Jardiance)® in addition to fluid restriction was effective in increasing the serum sodium concentration in 87 patients with SIAD-induced hyponatremia. The effect of empagliflozin (Jardiance)® without additional fluid restriction is however not yet known. Large randomized controlled trials have shown that SGLT2 inhibitors reduced hospitalization for heart failure in patients with, and more recently without type 2 diabetes. No studies have investigated the effect of SGLT2 inhibitors in hypervolemic hyponatremia.

To evaluate the effect of empagliflozin (Jardiance)® in eu- and hypervolemic hyponatremia, a randomized placebo-controlled study is needed.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
113

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Germany
      • Würzburg, Germany, 97080
        • University Hospital of Würzburg, med. Poliklinik
  • Netherlands
      • Rotterdam, Netherlands, 3015
        • Erasmus Universität Medisch Centrum Rotterdam, Department of Internal Medicine
  • Switzerland
      • Basel, Switzerland, 4031
        • University Hospital Basel
      • Biel, Switzerland, 2502
        • Spitalzentrum Biel
    • Canton of Lucerne
      • Lucerne, Canton of Lucerne, Switzerland, 6000
        • Kantonsspital Luzern
    • Canton of Vaud
      • Lausanne, Canton of Vaud, Switzerland, 1011
        • Centre Hospitalier Universitaire Vaudois (CHUV)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

- chronic eu- OR hypervolemic non hyperosmolar (<300 mOsm/kg) hyponatremia (heparin plasma sodium <135 mmol/L on day of inclusion)

Exclusion Criteria:

  • known hypersensitivity or allergy to class of drugs or the investigational product,
  • severe symptomatic hyponatremia in need of treatment with 3% NaCl-solution or in need of intensive/intermediate care treatment at time of inclusion
  • clinical hypovolemia
  • Severe reduction of eGFR <20 mL/min/1,73 m2 (KDIGO G4 and G5) or end stage renal disease
  • Chronic liver insufficiency with Child Pugh Score ≥10 or decompensated liver cirrhosis (jaundice, hepatorenal syndrome, encephalopathy, bleeding, …)
  • Hepatic impairment defined as aspartate transaminase (AST) or alanine transaminase (ALT) >3x the upper limit of normal (ULN); or total bilirubin >2x ULN at time of enrolment
  • uncontrolled hypothyroidism
  • uncontrolled adrenal insufficiency
  • systolic blood pressure <90mmHg
  • contraindication for lowering blood pressure
  • diabetes mellitus type 1 or pancreatic diabetes mellitus
  • treatment with SGLT2 inhibitors, lithium chloride, vaptans, demeclocycline or urea on inclusion day
  • severe immunosuppression (leucocytes <2 G/l)
  • peripheral arterial disease stage III-IV of the Fontaine Classification
  • fasting or other reasons preventing medication intake
  • previous enrolment into the current study
  • participation in another intervention study
  • pregnancy, breastfeeding, intention to become pregnant during the course of the study or lack of safe contraception.
  • end of life care

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Empagliflozin

Empagliflozin (Jardiance)® 25mg per os once daily for 30 days
Drug: Empagliflozin 25 MG

Empagliflozin 25mg per os once daily for 30 days
Placebo Comparator: Placebo

Placebo (Lactose tablet) per os once daily for 30 days
Drug: Placebo

Placebo per os once daily for 30 days

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in average daily area under curve (AUC) for serum sodium concentration
Time Frame: 4 days

Change in average daily AUC for serum sodium concentration
4 days
Long-term serum sodium change (before/after treatment)
Time Frame: 30 days

Absolute change in serum sodium concentration from baseline to end of treatment
30 days

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Impact intervention on bodyweight
Time Frame: 30 days

change of bodyweight
30 days
Impact intervention on blood pressure
Time Frame: 30 days

change of blood pressure
30 days
Course of serum sodium level
Time Frame: 30 days

Course of serum sodium level
30 days
Change of plasma osmolality
Time Frame: 30 days

Change of plasma osmolality
30 days
Change of urinary osmolality
Time Frame: 30 days

Change of urinary osmolality
30 days
Change of plasma urea
Time Frame: 30 days

Change of plasma urea
30 days
Change of urinary urea
Time Frame: 30 days

Change of urinary urea
30 days
Change of plasma uric acid
Time Frame: 30 days

Change of plasma uric acid
30 days
Change of urinary uric acid
Time Frame: 30 days

Change of urinary uric acid
30 days
Change of plasma creatinin
Time Frame: 30 days

Change of plasma creatinin
30 days
Change of urinary creatinin
Time Frame: 30 days

Change of urinary creatinin
30 days
Change of plasma potassium
Time Frame: 30 days

Change of plasma potassium
30 days
Change of urinary potassium
Time Frame: 30 days

Change of urinary potassium
30 days
Change in plasma copeptin
Time Frame: 30 days

Change in plasma copeptin
30 days
Change in plasma aldosterone
Time Frame: 30 days

Change in plasma aldosterone
30 days
Change in plasma renin
Time Frame: 30 days

Change in plasma renin
30 days
Change in plasma MR-proANP
Time Frame: 30 days

Change in plasma MR-proANP
30 days
Change in plasma NT-proBNP
Time Frame: 30 days

Change in plasma NT-proBNP
30 days
Change in plasma CTX
Time Frame: 30 days

Change in plasma CTX
30 days
Change in plasma P1NP
Time Frame: 30 days

Change in plasma P1NP
30 days
Occurence of thirst
Time Frame: 30 days

Occurence of thirst
30 days
Occurence of headache
Time Frame: 30 days

Occurence of headache
30 days
Occurence of vertigo
Time Frame: 30 days

Occurence of vertigo
30 days
Occurence of nausea
Time Frame: 30 days

Occurence of nausea
30 days
Change in general well-being
Time Frame: 30 days

Change in general well-being according to visual analogue scale
30 days
Change in quality of life
Time Frame: 30 days

change in quality of life according to EQ-5D-5L questionnaire
30 days
Change in cognitive impairment
Time Frame: 30 days

Change in cognitive impairment measured with the MoCa test
30 days
Change in visual attention
Time Frame: 30 days

Change in visual attention measured with the trail making test
30 days
Change in neuromuscular impairment
Time Frame: 30 days

Change in neuromuscular impairment measured with the timed up and go test
30 days
Change in grip strength
Time Frame: 30 days

Change in grip strength measured with a hand dynamometer
30 days
Occurence of falls
Time Frame: 30 days

Occurence of falls
30 days
Occurence of fractures
Time Frame: 30 days

Occurence of fractures
30 days
Length of hospital stay
Time Frame: 30 days

Length of hospital stay
30 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University Hospital, Basel, Switzerland

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Centre Hospitalier Universitaire Vaudois
Luzerner Kantonsspital

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Julie Refardt, MD, University Hospital, Basel, Switzerland

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 4, 2021

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 17, 2026

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 17, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 10, 2020

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 22, 2020

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 25, 2020

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 22, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 18, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • EMPOWER study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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