#2598 Impact of empagliflozin on metabolic profile, anthropometric indices, and renal function in chronic kidney disease patients with non-alcoholic fatty liver disease

Abstract Background and Aims Increased life expectancy and living conditions have contributed to an increase in comorbidities and metabolic disorders. 25%–30% of the adult population suffers from non-alcoholic fatty liver disease (NAFLD), while chronic kidney disease (CKD) affects 10%–15%. The aim of the study was to evaluate the impact of empagliflozin on the metabolic, anthropometric and kidney parameters in CKD patients with coexisting NAFLD. Method The study involved 41 patients, including 25 women and 16 men. Patients aged 38 to 75 years, the average age was 67.5 years. Patients were divided into main (23 patients) and control groups (18 patients). The study did not include patients with type 1 diabetes mellitus, eGFR less than 30 ml/min/1.73 m2, patients over 85 years old, viral hepatitis, storage diseases (Wilson disease, hemochromatosis), drug-induced and alcoholic liver pathologies. NAFLD was diagnosed according to the 2016 EASL-EASD-EASO guidelines. The study covered 25 patients (60.9%) with CKD stage 3a and 16 patients (39.1%) with CKD stage 3b. Platelets, aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, creatinine, body mass index (BMI), waist circumference, ultrasound examination of the liver and kidneys, hepatic steatosis index (HSI), NAFLD fibrosis score, ALD/NAFLD index (ANI), glomerular filtration rate (GFR) were studied in patients before and after the study. Antihypertensive, hypoglycemic drugs were continued according to standard therapy. Patients of the main group were prescribed empagliflozin 10 mg/day in addition to standard therapy. The duration of the study was 16 weeks. 1 patient was excluded from the study due to genital candidiasis. As the last point of the study, an improvement in laboratory, instrumental and anthropometric parameters was obtained. Results After the end of the study the main group of patients demonstrated significant improvements across multiple parameters. Platelet count increased from 244.9 × 109/l to 318.1 × 109/l (by 23.1%), albumin from 36 g/l to 45 g/l (by 20%), AST from 38 mmol/l to 30 mmol/l (by 21.1%), ALT from 41 mmol/l to 32 mmol/l (by 21.9%), creatinine decreased from 114.2 μmol/l to 88.1 μmol/l (by 22.9%). Anthropometric indices also improved: BMI improved from 34.23 kg/m2 to 27.6 kg/m2 (by 19.4%), waist circumference from 119 cm to 97 cm (by 18.5%). Liver ultrasound findings indicated a reduction in hepatosis severity, decreased from grade 1.64 to grade 1.33 (by 18.9%). Key NAFLD biomarkers also improved: HSI index from 44 to 34.8 (by 21%), NAFLD fibrosis index from −0.58 to −0.55 (by 5.2%), ANI from −89.9 to −94.8 (by 5.2%). eGFR increased from 37 ml/min/1.73 m2 to 48 ml/min/1.73 m2 (22.9%). In contrast, patients in the control group did not show significant changes in laboratory, instrumental, or anthropometric parameters. Conclusion The study demonstrated that the use of empagliflozin in chronic kidney disease patients coexisting with non-alcoholic fatty liver disease is associated with improvements in the metabolic, anthropometric parameters, and has a nephroprotective effect. However, additional large-scale and long-term studies are required to further elucidate the therapeutic benefits of empagliflozin and to determine its definitive impact on CKD and NAFLD outcomes.

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