Effect of Empagliflozin in Patients With eGFR Between 10 and 20 ml/Min/1.73m2

The proximal tubule remains the main site for sodium reabsorption in patients with advanced renal failure. The investigators therefore hypothesize that SGLT2i should still exert a significant natriuretic effect in patients with eGFR below 20 ml/min/1.73m2, and therefore should still decrease proteinuria with a potential renal protective effect.

Inclusion Criteria: * type 2 diabetics, * age between 18 and 80 years, * RAS blockade at maximal tolerated dosage for 1 month, * eGFR (CKD-EPI) between 10 and 20 ml/min/1.73m2, * UACR \> 300mg/g creatinine and UPCR \> 500mg/g creatinine, * office systolic blood pressure \> 110 mmHg, * stable dosage of antihypertensive drugs and diuretics for 1 month. Exclusion Criteria: * any medical condition that, in the opinion of the investigator makes the participant not suitable for inclusion, * history of ketoacidosis in the past while on empagliflozin or any other SGLT2i class drugs, * participation in another clinical study with an investigational medicinal product (IMP) administered during the month before screening, * known hypersensitivity or intolerance to empagliflozin or any of the excipients of the product, * judgment by the investigator that the participant should not participate in the study if the participant is unlikely to comply with study procedures, restrictions, and requirements, * no social insurance, * unwilling to give informed consent, vulnerable persons (minors, adults under guardianship or trusteeship, pregnant women, persons deprived of their liberty, persons unable to speak French).