P3.M259: Impact of Empagliflozin on Hyperfiltration in Youth with Type 2 Diabetes: Post Hoc Analysis of the DINAMO & DINAMO MONO Trials

Background: Hyperfiltration, common in youth with T2D, may increase risk for early diabetic kidney disease (DKD). The DINAMO trial showed empagliflozin vs placebo provided durable, clinically relevant improvements in glycemic control in youth aged 10–17 years with T2D. This post hoc analysis examined changes in eGFR with empagliflozin vs placebo in the DINAMO & DINAMO MONO trials (the latter were drug naïve or not on active therapy).

Methods: We estimated eGFR using the Zappitelli combined creatinine and cystatin C equation, with hyperfiltration defined as 2 SDs above the mean for healthy youth per NHANES (>126.8 mL/min per 1.73 m2). After randomization, 116 participants received once daily empagliflozin 10 or 25 mg vs placebo. We compared eGFR responses to therapy from baseline to Week 26 stratified by hyper- and normofiltration (eGFR >126.8 and ≤126.8 mL/min per 1.73 m2, respectively), with empagliflozin dosing groups pooled.

Results: At baseline, there were 55 youth (47%) with hyperfiltration; both subgroups were of similar age and pubertal status. In the hyperfiltration subgroup at Week 26, mean eGFR had decreased substantially with empagliflozin vs placebo (Figure). In the normofiltration subgroup, mean eGFR changes between groups were similar.

Conclusion: Treatment with empagliflozin was associated with attenuated hyperfiltration in youth with T2D. The potential long-term effects of such changes on DKD risk are unclear.