Empagliflozin Linked to Lower Risk of Advanced Kidney Disease Than Dapagliflozin in Stage 3 CKD: Study

A new study published in the journal of BMC Nephrology showed that over the course of around 2.5 years of follow-up, patients with Stage 3 chronic kidney disease (CKD) who started empagliflozin were less likely than those who started dapagliflozin to advance to Stage 5 CKD or end-stage kidney disease (ESKD).

Nephrology has been transformed with the introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors, which provide previously unheard-of kidney protection. Among these medications, empagliflozin and dapagliflozin have become mainstay treatments due to their exceptional ability to lower proteinuria and halt the decline in estimated glomerular filtration rate (eGFR).

Direct head-to-head comparisons assessing their particular renoprotective effects in stage 3 CKD are still of great clinical interest, despite the fact that their unique advantages have been well-documented in seminal clinical trials. Optimizing patient-tailored treatment plans requires an understanding of the relative effectiveness of empagliflozin and dapagliflozin. In order to determine if minor pharmacological variations result in clear therapeutic benefits, this investigation looks at their individual kidney results. Thus, the effectiveness of empagliflozin and dapagliflozin for renal outcomes in stage 3 chronic kidney disease was examined in this study.

Data from a network of 103 North American organizations were used in a propensity score-matched cohort study. Researchers examined adults with Stage 3 CKD who started using either dapagliflozin or empagliflozin between January 1, 2021, and December 31, 2023. The composite of end-stage renal disease or stage 5 CKD was the main outcome. Follow-up continues for up to three years (censored on April 3, 2026) or until the outcome is determined.

Empagliflozin was started for 53,887 and dapagliflozin for 27,344 patients with Stage 3 CKD, respectively. Empagliflozin beginning was linked to a decreased incidence of Stage 5 CKD or ESKD (7.7% vs. 9.0%; HR: 0.84; 95% CI: 0.79 to 0.89; log-rank P<0.001) after about 970 days among matched patients with Stage 3 CKD (N = 26,911 per group).

The groups' all-cause death rates were comparable. The empagliflozin group had decreased incidence of ESKD and stage 5 CKD. Overall, patients with Stage 3 CKD who started empagliflozin instead of dapagliflozin over about 2.5 years had a decreased probability of developing Stage 5 CKD or ESKD. Although these results point to a possible renal benefit for empagliflozin, prospective randomized trials are required to validate the benefit.

Source:

Bharati, J., Bosch, N. A., & Upadhyay, A. (2026). Empagliflozin versus dapagliflozin for kidney outcomes in stage 3 chronic kidney disease: a propensity score-matched multi-center cohort study. BMC Nephrology. https://doi.org/10.1186/s12882-026-05111-9