Book Review

Review of: ANN RAPPAPORT & MARGARET FRESHER FLAHERTY, CORPORATE RESPONSES TO ENVIRONMENTAL CHALLENGES: INITIATIVES BY MULTINATIONAL MANAGEMENT. (Quorum Books 1992) [186 pp.] Acknowledgements, bibliography, figures, foreword, index, notes, tables. LC: 91-44706; ISBN: 0-89930-715-9 [Cloth $45.00.

Book Review

Review of the following: BIOMEDICAL POLITICS. (Kathi E. Hanna, ed., National Academy Press 1991) [352 pp.] Preface and acknowledgements, Carl W. Gottschalk, Chair, Institute of Medicine Committee to Study Biomedical Decision Making. Appendices, biographical notes on authors and commentators, index, notes, references. LC 91- 18394, ISBN 0-309-04486-3. [Cloth $29.95. Export$36.00. 2101 Constitution Ave., NW, Washington DC 20418.

Book Review

Review of the book: ENVIRONMENTAL POLITICS: PUBLIC COSTS, PRIVATE REWARDS. (Michael S. Greve & Fred L. Smith, Jr. eds., Praeger 1992) [209 pp.] Acknowledgements, biographical information, figures, foreword by James Q. Wilson, index, notes, selected bibliography, tables. LC 91-44009, ISBN 0-275- 94238-4. [Paper $19.95, cloth$45.00. One Madison Avenue, New York N.Y. 10010.

Promoting and Managing Genome Innovation

An introduction to the symposium, Promoting and Managing Genome Innovation held October 1995. The conference was organized by Professor Thomas G. Field, Jr. and Gianna Julian-Arnold. The conference was funded in part by the Ethical, Legal and Social Issues component of the D.O.E. Human Genome Program; Nixon, Hargrave, Devans & Doyle L.L.P., Rochester, N.Y.; and Human Genome Sciences

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo