Heart Failure
Conditions
Brief summary
This is a study in adults with chronic heart failure. People with chronic heart failure may need to be hospitalised for their condition. Some people with chronic heart failure may eventually die from their condition. The purpose of the study is to find out whether a medicine called empagliflozin lowers the chances of patients having to go to hospital for heart failure and whether it improves their survival. The study is open to patients with a type of chronic heart failure called chronic heart failure with preserved ejection fraction. Participants stay in the study until researchers have enough information about how effective empagliflozin is. It is expected that participants who enter at the very beginning of the enrolment period may be in the study for over 3 years, while participants who enter near the end of the enrolment period may be in the study for less than 2 years. The participants are put into 2 groups. It is decided by chance who gets into which group. One group gets empagliflozin tablets every day and the other group gets placebo tablets every day. Placebo tablets look like empagliflozin tablets but contain no medicine. Participants visit the doctors regularly. During these visits, the doctors collect information about the participant's health. The doctors want to know how many patients had to go to hospital because of heart failure or who died from cardiovascular disease.
Interventions
once daily
once daily
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female patient, age \>= 18 years at screening. For Japan only: Age \>=20 years at screening * Patients with chronic HF (Chronic Heart Failure) NYHA (New York Heart Association classification) class II-IV and preserved EF (Ejection Fraction)(LVEF (Left Ventricular Ejection Fraction) \> 40 %) and elevated NT-proBNP (N-terminal of the prohormone brain natriuretic peptide) \> 300 pg/ml for patients without AF, OR \> 900 pg/ml for patients with AF, analysed at the Central laboratory at Visit 1 * Structural heart disease within 6 months prior to Visit 1, OR documented HHF (Hospitalisation for Heart Failure) within 12 months prior to Visit 1 * Stable dose of oral diuretics, if prescribed * Signed and dated written ICF (informed consent form) * Further inclusion criteria apply
Exclusion criteria
* Myocardial infarction, coronary artery bypass graft surgery or other major cardiovascular surgery, stroke or TIA (Transient Ischaemic Attack) in past 90 days prior to Visit 1 * Heart transplant recipient or listed for heart transplant * Acute decompensated HF (Heart Failure) * Systolic blood pressure (SBP) \>= 180 mmHg at Visit 2. * Symptomatic hypotension and/or a SBP \< 100 mmHg * Indication of liver disease, * Impaired renal function, defined as eGFR (Estimated Glomerular Filtration Rate) \< 20 mL/min/1.73 m2 (CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration Equation))cr or requiring dialysis * History of ketoacidosis * Current use or prior use of a SGLT (Sodium-glucose co-transporter) -2 inhibitor or combined SGLT-1 and 2 inhibitor * Currently enrolled in another investigational device or drug trial * Known allergy or hypersensitivity to empagliflozin or other SGLT-2 inhibitors * Women who are pregnant, nursing, or who plan to become pregnant while in the trial * Further
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Event of Adjudicated Cardiovascular (CV) Death or Adjudicated Hospitalisation for Heart Failure (HHF) | From randomization until completion of the planned treatment phase, up to 1403 days. | Failure with preserved Ejection Fraction (HFpEF). The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| eGFR (CKD-EPI) cr Slope of Change From Baseline | At baseline, week 4, 12, 32, 52, 76, 100, 124, 148, 172 and week 196, up to 1043 days. | Glomerular filtration rate estimated by the chronic kidney disease epidemiology collaboration formula with serum creatinine measurement (eGFR(CKD-EPI)cr) slope of change from baseline. Available on-treatment change-from-baseline data were used. The slope represents the long term effect of eGFR change from baseline and provides the yearly rate of decline. Timepoints after baseline were included in calculation of slope of change from baseline. The slope per patient was calculated using a random coefficient model with terms for treatment, region, baseline status of diabetes, age, sex, left ventricular ejection fraction (LVEF) and glomerular filtration rate estimated by the chronic kidney disease epidemiology collaboration formula (eGFR (CKD-EPI)cr) at baseline and in addition the factors time, treatment-by-time interaction, and baseline eGFR (CKD-EPI)cr-by-time interaction. |
| Time to the First Event in the Composite Renal Endpoint: Chronic Dialysis, Renal Transplant, or Sustained Reduction in eGFR (CKD-EPI)cr | From randomization until completion of the planned treatment phase, up to 1403 days. | Chronic dialysis was defined as dialysis with a frequency of twice per week or more for at least 90 days. Sustained was determined by two or more consecutive post-baseline central laboratory measurement separated by at least 30 days. Reduction in glomerular filtration rate estimated by the chronic kidney disease epidemiology collaboration formula with serum creatinine measurement (eGFR (CKD-EPI)cr) was defined as reduction in eGFR from baseline ≥40%, eGFR \<15 mL/min/1.73 m\^2 for patients with baseline eGFR ≥30 mL/min/1.73 m\^2, or eGFR \<10 mL/min/1.73 m\^2 for patients with baseline eGFR \<30 mL/min/1.73 m\^2. The incidence rate per 100 patient years (100 \* number of patients with event / time at risk \[years\]) is reported. Time at risk \[year\] is calculated as: Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Abbreviation: Patient-years (pt-yrs). |
| Time to First Adjudicated Hospitalisation for Heart Failure (HHF) | From randomization until completion of the planned treatment phase, up to 1403 days. | Time to first adjudicated HHF. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier. |
| Time to Adjudicated Cardiovascular (CV) Death | From randomization until completion of the planned treatment phase, up to 1403 days. | Time to adjudicated CV death. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier. |
| Occurrence of Adjudicated Hospitalisation for Heart Failure (HHF) (First and Recurrent) | From randomization until completion of the planned treatment phase, up to 1403 days. | Reported is the total number of adjudicated HHF events (first and recurrent) which occurred. |
| Time to Onset of Diabetes Mellitus (DM) in Patients With Pre-DM | From randomization until completion of the planned treatment phase, to 1403 days. | Time to onset of DM (defined as HbA1c ≥6.5% or as diagnosed by the investigator) in patients with pre-DM. Pre-DM was defined as no history of DM and no HbA1c ≥6.5% before treatment, and a pre-treatment HbA1c value of ≥5.7% and \<6.5%. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier. |
| Change From Baseline in Kansas City Cardiomyopathy Questionaire (KCCQ) Clinical Summary Score at Week 52 | At baseline and at week 12, week 32 and week 52. | The KCCQ is a 23-item self-administered questionnaire designed to evaluate physical limitations, symptoms (frequency, severity, and changes over time), social limitations, self-efficacy, and quality of life in patients with Heart Failure. The KCCQ-clinical summary score comprises the following domains: Symptom frequency, symptom burden and physical limitation. The score is calculated by summing domain responses and then transforming scores to a 0-100 unit scale with higher scores indicating better health status. For patients who died, a worst score (score of 0) was imputed for the score at all subsequent scheduled visits after the date of death where the score would have been assessed. Change from baseline in KCCQ-score at week 52 was modeled using a MMRM with visit (week 12, 32 and 52) as repeated measures, adjusted mean (standard error) at week 52 is reported. |
| Occurrence of All-cause Hospitalisation (First and Recurrent) | From randomization until completion of the planned treatment phase, up to 1403 days. | Occurrence of all-cause hospitalisation (first and recurrent). Total number of all cause hospitalisations is reported. |
| Time to All-cause Mortality | From randomization until completion of the planned treatment phase, up to 1403 days. | Time to all-cause mortality. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier. |
Countries
Argentina, Australia, Belgium, Brazil, Canada, China, Colombia, Czechia, Germany, Hungary, India, Italy, Japan, Mexico, Netherlands, Poland, Romania, Singapore, South Africa, South Korea, Spain, United Kingdom, United States
Participant flow
Recruitment details
A randomised, double-blind trial to demonstrate superiority of empagliflozin versus placebo in patients with symptomatic, chronic heart failure and preserved left ventricular ejection fraction (LVEF\>40%) under stable treatment of heart failure symptoms.
Pre-assignment details
Patients were included in the trial after they had signed the informed consent form (ICF). Patients who met all of the inclusion and none of the exclusion criteria were to be included in the trial. All patients were informed that they were free to withdraw their consent at any time during the trial without penalty or prejudice.
Participants by arm
| Arm | Count |
|---|---|
| Placebo 1 film-coated tablet of matching placebo was administered orally once daily in patients with chronic heart failure with preserved ejection fraction (HFpEF). | 2,991 |
| 10 mg Empagliflozin 1 film-coated tablet of 10 milligram (mg) of empagliflozin was administered orally once daily in patients with chronic heart failure with preserved ejection fraction (HFpEF). | 2,997 |
| Total | 5,988 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 553 | 575 |
| Overall Study | Due to Covid-19 Pandemic | 2 | 8 |
| Overall Study | Investigator decision | 2 | 0 |
| Overall Study | Lost to Follow-up | 6 | 16 |
| Overall Study | Medical advice | 6 | 2 |
| Overall Study | Not attending study visits | 3 | 0 |
| Overall Study | Not treated | 2 | 1 |
| Overall Study | Other reason than stated above | 23 | 29 |
| Overall Study | Patient decision | 5 | 2 |
| Overall Study | Patient moved away | 3 | 4 |
| Overall Study | Patient refusal to continue, not due to AE | 304 | 284 |
| Overall Study | Protocol Violation | 30 | 24 |
| Overall Study | Study drug stopped, reason missing | 6 | 1 |
Baseline characteristics
| Characteristic | 10 mg Empagliflozin | Total | Placebo |
|---|---|---|---|
| Age, Continuous | 71.8 Years STANDARD_DEVIATION 9.3 | 71.9 Years STANDARD_DEVIATION 9.4 | 71.9 Years STANDARD_DEVIATION 9.6 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 770 Participants | 1524 Participants | 754 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 2227 Participants | 4463 Participants | 2236 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 90 Participants | 194 Participants | 104 Participants |
| Race (NIH/OMB) Asian | 413 Participants | 824 Participants | 411 Participants |
| Race (NIH/OMB) Black or African American | 133 Participants | 258 Participants | 125 Participants |
| Race (NIH/OMB) More than one race | 60 Participants | 135 Participants | 75 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 14 Participants | 33 Participants | 19 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 2 Participants | 1 Participants |
| Race (NIH/OMB) White | 2286 Participants | 4542 Participants | 2256 Participants |
| Sex: Female, Male Female | 1338 Participants | 2676 Participants | 1338 Participants |
| Sex: Female, Male Male | 1659 Participants | 3312 Participants | 1653 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 427 / 2,991 | 422 / 2,997 |
| other Total, other adverse events | 1,274 / 2,989 | 1,191 / 2,996 |
| serious Total, serious adverse events | 1,543 / 2,989 | 1,436 / 2,996 |
Outcome results
Time to First Event of Adjudicated Cardiovascular (CV) Death or Adjudicated Hospitalisation for Heart Failure (HHF)
Failure with preserved Ejection Fraction (HFpEF). The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier.
Time frame: From randomization until completion of the planned treatment phase, up to 1403 days.
Population: Randomised Set (RS), including all randomised patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Time to First Event of Adjudicated Cardiovascular (CV) Death or Adjudicated Hospitalisation for Heart Failure (HHF) | 8.67 Patients with event/100 pt-yrs at risk |
| 10 mg Empagliflozin | Time to First Event of Adjudicated Cardiovascular (CV) Death or Adjudicated Hospitalisation for Heart Failure (HHF) | 6.86 Patients with event/100 pt-yrs at risk |
Change From Baseline in Kansas City Cardiomyopathy Questionaire (KCCQ) Clinical Summary Score at Week 52
The KCCQ is a 23-item self-administered questionnaire designed to evaluate physical limitations, symptoms (frequency, severity, and changes over time), social limitations, self-efficacy, and quality of life in patients with Heart Failure. The KCCQ-clinical summary score comprises the following domains: Symptom frequency, symptom burden and physical limitation. The score is calculated by summing domain responses and then transforming scores to a 0-100 unit scale with higher scores indicating better health status. For patients who died, a worst score (score of 0) was imputed for the score at all subsequent scheduled visits after the date of death where the score would have been assessed. Change from baseline in KCCQ-score at week 52 was modeled using a MMRM with visit (week 12, 32 and 52) as repeated measures, adjusted mean (standard error) at week 52 is reported.
Time frame: At baseline and at week 12, week 32 and week 52.
Population: Only Patients included in the treated set (TS) including values obtained on treatment. The number of patients analysed displays the number of patients with available data at the timepoint of interests.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Kansas City Cardiomyopathy Questionaire (KCCQ) Clinical Summary Score at Week 52 | 3.18 Score on a scale | Standard Error 0.31 |
| 10 mg Empagliflozin | Change From Baseline in Kansas City Cardiomyopathy Questionaire (KCCQ) Clinical Summary Score at Week 52 | 4.51 Score on a scale | Standard Error 0.31 |
eGFR (CKD-EPI) cr Slope of Change From Baseline
Glomerular filtration rate estimated by the chronic kidney disease epidemiology collaboration formula with serum creatinine measurement (eGFR(CKD-EPI)cr) slope of change from baseline. Available on-treatment change-from-baseline data were used. The slope represents the long term effect of eGFR change from baseline and provides the yearly rate of decline. Timepoints after baseline were included in calculation of slope of change from baseline. The slope per patient was calculated using a random coefficient model with terms for treatment, region, baseline status of diabetes, age, sex, left ventricular ejection fraction (LVEF) and glomerular filtration rate estimated by the chronic kidney disease epidemiology collaboration formula (eGFR (CKD-EPI)cr) at baseline and in addition the factors time, treatment-by-time interaction, and baseline eGFR (CKD-EPI)cr-by-time interaction.
Time frame: At baseline, week 4, 12, 32, 52, 76, 100, 124, 148, 172 and week 196, up to 1043 days.
Population: Only patients included in the treated set (TS) and with available data for this endpoint.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo | eGFR (CKD-EPI) cr Slope of Change From Baseline | -2.616 mL/min/ 1.73 meters squared/year | Standard Deviation 0.108 |
| 10 mg Empagliflozin | eGFR (CKD-EPI) cr Slope of Change From Baseline | -1.253 mL/min/ 1.73 meters squared/year | Standard Deviation 0.108 |
Occurrence of Adjudicated Hospitalisation for Heart Failure (HHF) (First and Recurrent)
Reported is the total number of adjudicated HHF events (first and recurrent) which occurred.
Time frame: From randomization until completion of the planned treatment phase, up to 1403 days.
Population: Randomised Set (RS), including all randomised patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Occurrence of Adjudicated Hospitalisation for Heart Failure (HHF) (First and Recurrent) | 541 HHF events |
| 10 mg Empagliflozin | Occurrence of Adjudicated Hospitalisation for Heart Failure (HHF) (First and Recurrent) | 407 HHF events |
Occurrence of All-cause Hospitalisation (First and Recurrent)
Occurrence of all-cause hospitalisation (first and recurrent). Total number of all cause hospitalisations is reported.
Time frame: From randomization until completion of the planned treatment phase, up to 1403 days.
Population: Randomised Set (RS), including all randomised patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Occurrence of All-cause Hospitalisation (First and Recurrent) | 2769 Events of all-cause hospitialisations |
| 10 mg Empagliflozin | Occurrence of All-cause Hospitalisation (First and Recurrent) | 2566 Events of all-cause hospitialisations |
Time to Adjudicated Cardiovascular (CV) Death
Time to adjudicated CV death. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier.
Time frame: From randomization until completion of the planned treatment phase, up to 1403 days.
Population: Randomised Set (RS), including all randomised patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Time to Adjudicated Cardiovascular (CV) Death | 3.81 Patients with event /100 pt-yrs at risk |
| 10 mg Empagliflozin | Time to Adjudicated Cardiovascular (CV) Death | 3.42 Patients with event /100 pt-yrs at risk |
Time to All-cause Mortality
Time to all-cause mortality. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier.
Time frame: From randomization until completion of the planned treatment phase, up to 1403 days.
Population: Randomised Set (RS), including all randomised patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Time to All-cause Mortality | 6.67 Patients with event /100 pt-yrs at risk |
| 10 mg Empagliflozin | Time to All-cause Mortality | 6.60 Patients with event /100 pt-yrs at risk |
Time to First Adjudicated Hospitalisation for Heart Failure (HHF)
Time to first adjudicated HHF. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier.
Time frame: From randomization until completion of the planned treatment phase, up to 1403 days.
Population: Randomised Set (RS), including all randomised patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Time to First Adjudicated Hospitalisation for Heart Failure (HHF) | 5.97 Patients with event /100 pt-yrs at risk |
| 10 mg Empagliflozin | Time to First Adjudicated Hospitalisation for Heart Failure (HHF) | 4.28 Patients with event /100 pt-yrs at risk |
Time to Onset of Diabetes Mellitus (DM) in Patients With Pre-DM
Time to onset of DM (defined as HbA1c ≥6.5% or as diagnosed by the investigator) in patients with pre-DM. Pre-DM was defined as no history of DM and no HbA1c ≥6.5% before treatment, and a pre-treatment HbA1c value of ≥5.7% and \<6.5%. The incidence rate per 100 patient years (pt-yrs) is presented and calculated as followed: Incidence rate per 100 pt-yrs = 100 \* number of patients with event / time at risk \[years\]. Time at risk \[years\] = Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Patients without a specific endpoint event were censored at the last date the patient was known to be free of the event or at the end of the planned treatment period, whichever was earlier.
Time frame: From randomization until completion of the planned treatment phase, to 1403 days.
Population: Randomised Set (RS), including all randomised patients and with available data for this endpoint.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Time to Onset of Diabetes Mellitus (DM) in Patients With Pre-DM | 7.39 Patients with event /100 pt-yrs at risk |
| 10 mg Empagliflozin | Time to Onset of Diabetes Mellitus (DM) in Patients With Pre-DM | 6.12 Patients with event /100 pt-yrs at risk |
Time to the First Event in the Composite Renal Endpoint: Chronic Dialysis, Renal Transplant, or Sustained Reduction in eGFR (CKD-EPI)cr
Chronic dialysis was defined as dialysis with a frequency of twice per week or more for at least 90 days. Sustained was determined by two or more consecutive post-baseline central laboratory measurement separated by at least 30 days. Reduction in glomerular filtration rate estimated by the chronic kidney disease epidemiology collaboration formula with serum creatinine measurement (eGFR (CKD-EPI)cr) was defined as reduction in eGFR from baseline ≥40%, eGFR \<15 mL/min/1.73 m\^2 for patients with baseline eGFR ≥30 mL/min/1.73 m\^2, or eGFR \<10 mL/min/1.73 m\^2 for patients with baseline eGFR \<30 mL/min/1.73 m\^2. The incidence rate per 100 patient years (100 \* number of patients with event / time at risk \[years\]) is reported. Time at risk \[year\] is calculated as: Sum of time at risk \[days\] over all patients in a treatment group / 365.25. Abbreviation: Patient-years (pt-yrs).
Time frame: From randomization until completion of the planned treatment phase, up to 1403 days.
Population: Randomised Set (RS), including all randomised patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Time to the First Event in the Composite Renal Endpoint: Chronic Dialysis, Renal Transplant, or Sustained Reduction in eGFR (CKD-EPI)cr | 2.23 Patients with event /100 pt-yrs at risk |
| 10 mg Empagliflozin | Time to the First Event in the Composite Renal Endpoint: Chronic Dialysis, Renal Transplant, or Sustained Reduction in eGFR (CKD-EPI)cr | 2.13 Patients with event /100 pt-yrs at risk |