SGLT2 Inhibitors in Glomerular Hyperfiltration (EMPATHY)

Evaluating the Short-Term Renal and Systemic Effects of SGLT2 Inhibition in Non-Diabetic Patients at Risk of Accelerated GFR Decline Because of Glomerular Hyperfiltration: a Sequential OFF-ON-OFF Study With One-Month Empagliflozin Therapy Followed by One-Month Recovery Period

Glomerular hyperfiltration is a major risk factor for accelerated glomerular filtration rate (GFR) decline and renal and cardiovascular events despite optimized conservative therapy with blood pressure and blood glucose (in diabetics) lowering medications and inhibitors of the Renin Angiotensin System (RAS) such as Angiotensin Converting Enzyme (ACE) inhibitors and/or Angiotensin Receptor Blockers (ARBs).

Progressive GFR decline initiated and sustained by glomerular hyperfiltration in subjects with diabetes, unhealthy obesity, hypertension and other risk factors, is paralleled by progressive glomerulosclerosis and loss of functioning nephrons.

The inhibition of the sodium-glucose cotransporter 2 (SGLT2) in the proximal tubular segments of the nephrons appears to be an ideal, specific intervention to inhibit the tubulo-glomerular feedback and ameliorate glomerular hyperfiltration in subjects with absolute or relative hyperfiltration associated with unhealthy obesity or proteinuric chronic kidney disease (CKD). Indeed, by reducing tubular sodium reabsorption, SGLT2 inhibitors may enhance sodium chloride delivery to the macula densa, restore pre-glomerular resistances and therefore limit glomerular hyperperfusion and consequent hyperfiltration. Moreover, because of its natriuretic effects, SGLT2 inhibition therapy might reduce the sodium overload and volume expansion which, along with secondary hypertension, may further contribute to kidney hyperperfusion and glomerular hyperfiltration in obesity and CKD.

Study Overview

Status

Withdrawn

Intervention / Treatment

Study Type

Interventional

Phase

  • Phase 2

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

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Male and female ≥ 18 years old;
  2. Increased risk of accelerated renal function loss because of absolute or relative hyperfiltration associated with unhealthy obesity or residual proteinuria defined as:

    Unhealthy obesity:

    • BMI >30 kg/m^2 or waist circumference >94 cm in males and > 80 cm in females
    • Metabolic syndrome, defined as the presence of at least three of the following criteria:
    • Blood pressure>140/90 mmHg or controlled blood pressure under current antihypertensive treatment
    • Triglyceride levels >150 mg/dL
    • HDL<40 mg/dL in males <50 mg/dL in females
    • Fasting blood glucose > 100 and <125 mg/dL

    Residual proteinuria:

    • Urinary protein excretion >1g/24-h to <3g/24-h despite RAS inhibitor therapy with ACE inhibitors or ARBs;
    • Blood pressure in recommended targets with or without blood pressure lowering medications;
  3. Estimated GFR > 60 ml/min/1.73m^2 (CKD-EPI formula);
  4. Female childbearing potential and non-sterile male must agree to use a method of contraception;
  5. Written informed consent

Exclusion Criteria:

  1. Type 1or 2 diabetic patients;
  2. Concomitant treatment with insulin or oral hypoglycemic agents;
  3. Nephrotic syndrome of any etiology;
  4. Patients with Autosomal Dominant Polycystic Kidney Disease;
  5. Symptomatic urinary tract lithiasis or obstruction;
  6. Ischemic kidney disease (because of possible excess risk of acute kidney injury upon SGLT2 inhibition associated reduction in sodium pool and kidney perfusion pressure);
  7. Rapidly progressive kidney disease defined by impairment of renal function within 2 weeks - 3 months (for the cohort of patients with residual proteinuria only) ;
  8. Active systemic autoimmune diseases;
  9. Treatment for glomerulopathies or systemic diseases with steroids or any other immunosuppressive agent within one year;
  10. Specific contraindication to SGLT2 inhibitor therapy;
  11. Heart failure with or without decreased systolic function;
  12. Uncontrolled hypertension or symptomatic hypotension;
  13. History of malignancy within 5 years of screening;
  14. Inability to fully understand the possible risks and benefits related to study participation;
  15. If female, the subject is pregnant or lactating or intending to become pregnant before, during, or within 90 days after last dose; or intending to donate ova during such time period;
  16. If male, the subject intends to donate sperm while on the study this study or for 90 days after last dose;
  17. Alcohol and drug abuse;
  18. Participation in another interventional clinical trial within the 4 weeks prior to screening.

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: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: IMP
Empagliflozin 10 mg/die for 28 days
Other Names:
  • Jardiance

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Measured Glomerular Filtration Rate (GFR)
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
GFR will be measured by the iohexol plasma clearance technique
Changes from baseline to the end of one-month treatment period and one-month recovery period

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
24 hour urinary output
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary protein excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
mean of the measurement in three consecutive 24-hour urine collection
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary albumin excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
mean of the measurement in three consecutive 24-hour urine collection
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary urea excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary phosphate excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary sodium excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary glucose excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary potassium excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary uric acid excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour urinary creatinine excretion
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
last of three consecutive collections
Changes from baseline to the end of one-month treatment period and one-month recovery period
Fractional clearance of total protein calculated by standard formulas
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Fractional clearance of albumin calculated by standard formulas
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Fractional clearance of sodium calculated by standard formulas
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Fractional clearance of potassium calculated by standard formulas
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Fractional clearance of uric acid calculated by standard formulas
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Fractional clearance of free water calculated by standard formulas
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Glucose disposal rate
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Performed by hyperinsulinemic euglycemic clamp and by standard oral glucose load and HOMA index;
Changes from baseline to the end of one-month treatment period and one-month recovery period
Glucose tolerance
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Performed by hyperinsulinemic euglycemic clamp and by standard oral glucose load and HOMA index;
Changes from baseline to the end of one-month treatment period and one-month recovery period
Office blood pressure
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Office heart rate
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour (day-time and night-time) blood pressure monitoring
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
24 hour (day-time and night-time) heart rate monitoring
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
Changes from baseline to the end of one-month treatment period and one-month recovery period
Pulse wave velocity
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
These parameters will be measured by tonometry
Changes from baseline to the end of one-month treatment period and one-month recovery period
other marker of vascular stiffness
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
These parameters will be measured by tonometry
Changes from baseline to the end of one-month treatment period and one-month recovery period
Indices of Quality of Life: questionnaire SF-36
Time Frame: Changes from baseline to the end of one-month treatment period and one-month recovery period
By submission of validate questionnaire
Changes from baseline to the end of one-month treatment period and one-month recovery period

Collaborators and Investigators

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

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)

September 3, 2021

Primary Completion (Actual)

September 3, 2021

Study Completion (Actual)

September 3, 2021

Study Registration Dates

First Submitted

October 25, 2019

First Submitted That Met QC Criteria

October 28, 2019

First Posted (Actual)

October 29, 2019

Study Record Updates

Last Update Posted (Actual)

September 13, 2021

Last Update Submitted That Met QC Criteria

September 6, 2021

Last Verified

September 1, 2021

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

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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