The EMPA-KIDNEY trial demonstrated that, compared with placebo, empagliflozin 10 mg once daily reduced the risk of its primary composite outcome of kidney disease progression or cardiovascular death by 28% (95% confidence interval [CI] 18-36%) in 6609 patients with chronic kidney disease (CKD) at risk of progression.1,2 The aim of this embedded mechanistic substudy was to use multiparametric magnetic resonance imaging (MRI) to assess the effects of empagliflozin versus placebo on a MRI-based measure indicative of kidney fibrosis and inflammation (cortical longitudinal relaxation time [T1] mapping) at around 18 months after randomization.