Empagliflozin versus Dapagliflozin for Kidney Outcomes in Stage 3 Chronic Kidney Disease: A Propensity Score-Matched Multi-center Cohort Study

Background Sodium-glucose cotransporter 2 (SGLT2)-inhibitors are key in chronic kidney disease (CKD) management with empagliflozin and dapagliflozin being the two most commonly used. Comparative data between them in CKD is limited. Methods A propensity score-matched cohort study was conducted using data from a network of 103 North American organizations. Adults with Stage 3 CKD who initiated empagliflozin or dapagliflozin between January 1, 2021 and December 31, 2023, were compared. The primary outcomes was the composite of Stage 5 CKD or end-stage kidney disease (ESKD). Follow-up continued until outcome or up to 3 years (censored on May 4, 2025). Results 60,689 and 34,877 patients with Stage 3 CKD were initiated on empagliflozin and dapagliflozin, respectively. Among matched patients with Stage 3 CKD (N = 33,583 per group) empagliflozin initiation was associated with lower risk of Stage 5 CKD or ESKD (5.2% vs 6.2%; HR: 0.82; 95% CI: 0.77–0.88) over ~ 670 days. All-cause mortality was similar between groups. Stage 5 CKD and ESKD rates were lower in the empagliflozin group. Stage 5 CKD or ESKD was lower for patients initiated on both empagliflozin 25 mg daily and 10 mg daily compared to dapagliflozin 10 mg daily. Conclusion In this multi-center retrospective cohort study, the risk for Stage 5 CKD or ESKD was lower for patients with Stage 3 CKD who initiated empagliflozin versus dapagliflozin over ~ 2.0 years. Prospective studies are needed to confirm our findings.