Empagliflozin Versus Dapagliflozin for Kidney Outcomes in Stage 3 CKD

Key Takeaways

• Empagliflozin initiation was associated with fewer composite kidney outcome events than dapagliflozin in the matched comparison.
• The multicenter retrospective cohort used propensity score matching across 103 North American organizations and included 26,911 matched patients per group.
• All-cause mortality was similar between groups, and the authors said prospective studies are needed to confirm the findings.

In adults with stage 3 chronic kidney disease, empagliflozin was associated with fewer composite kidney events than dapagliflozin, 7.7% versus 9.0%, in a multicenter matched cohort reported in BMC Nephrology. The comparison used propensity score matching to assess routine-practice outcomes after treatment initiation across a large North American data network. Both drugs were evaluated head to head within the same real-world framework.

Published June 11, 2026, the propensity score-matched multicenter retrospective cohort used data from 103 North American organizations. Adults with stage 3 CKD who initiated empagliflozin or dapagliflozin from January 1, 2021, through December 31, 2023, were included, and matching yielded 26,911 patients in each group. Follow-up continued until the outcome occurred or for as long as 3 years, with censoring on April 3, 2026; the matched cohort accrued about 970 days of follow-up. Before matching, 53,887 patients started empagliflozin and 27,344 started dapagliflozin.

The primary outcome was a composite of stage 5 CKD or end-stage kidney disease. In the matched analysis, empagliflozin initiation was associated with a lower risk of that endpoint than dapagliflozin, with HR 0.84, 95% CI 0.79 to 0.89, and log-rank P<0.001. Investigators also observed lower rates of stage 5 CKD and end-stage kidney disease with empagliflozin.

All-cause mortality was similar between the empagliflozin and dapagliflozin groups during follow-up in this retrospective observational comparison. The authors said prospective studies are needed to confirm these findings in adults with stage 3 CKD.