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Our primary aim was to assess empagliflozin's effect on glomerular filtration rate and renal vascular resistance using multiparametric MRI (MpMRI). Our secondary aim was to assess the impact of empagliflozin on additional MpMRI\u2010derived metrics including markers of tissue oxygenation and microstructure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      Prospective randomised open\u2010label crossover clinical trial of adults with T2DM with eGFR \u2265\u200945\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      and any degree of albuminuria (CKD KDIGO G1, 2 or GF3a, A1\u2013A3). MpMRI was performed at baseline and 12\u2010weeks post\u2010empagliflozin or active comparator sitagliptin therapy in random order with an interval washout period. Brochner\u2010Mortensen corrected MRI\u2010derived GFR (MRI\u2010GFR), renal vascular resistance (RVR), renal blood flow (RBF) and markers of tissue hypoxia (R2*) and microstructure were measured. Impact of empagliflozin or sitagliptin on MpMRI and laboratory metrics were assessed with mixed\u2010effect linear regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twelve participants (8 male, 4 female) completed all study visits. Following empagliflozin, there were significant mean decreases in MRI\u2010GFR (3.03\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      ) and RBF (41.24\u2009mL\/min) and increased medullary hypoxia (R2* 1.81\u2009s\n                      <jats:sup>\u22121<\/jats:sup>\n                      ) compared to sitagliptin, all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05. There were no statistically significant changes to RVR, corticomedullary microstructure, eGFR or albuminuria observed with empagliflozin.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multiparametric MRI can non\u2010invasively demonstrate local renal impacts of empagliflozin beyond that of traditional markers of renal function, including decreased GFR and medullary hypoxia. Lack of RVR change may relate to lower systemic blood pressure, concurrent medication and efferent arteriolar vasodilation in T2DM.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      ACTRN12619000933156\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70950","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:04:11Z","timestamp":1780635851000},"page":"7416-7429","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multi\u2010Parametric Magnetic Resonance Imaging to Assess Empagliflozin Effect on the Kidneys in People With Type 2 Diabetes Mellitus: A Pilot Clinical Trial"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2842-5997","authenticated-orcid":false,"given":"Ruth 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