Canagliflozin shows positive renal results in type 2 diabetes

The sodium-glucose co-transporter-2 (SGLT2) inhibitor, canagliflozin, significantly reduces the risk of renal failure, dialysis or kidney transplantation, and renal or cardiovascular (CV) death in patients with type 2 diabetes, according to a new trial.

The CREDENCE study, published in the New England Journal of Medicine was conducted in more than 4400 adults with type 2 diabetes at 659 sites worldwide, including 37 locations across the UK.

Canagliflozin reduced the risk of a composite of doubling of serum creatinine, end-stage kidney disease (ESKD) and renal or CV death by 30% (HR 0.70; 95% CI 0.59–0.82; p<0.0001). These findings were consistent across the individual components of the primary composite endpoint.

In addition, canagliflozin reduced the risk of the secondary renal endpoint composite of doubling of serum creatinine, ESKD, and renal death by 34% (HR 0.66; 95% CI 0.53–0.81; p<0.0001); the risk of major adverse cardiac events (composite of non-fatal myocardial infarction, non-fatal stroke and CV death) by 20% (HR 0.80; CI 0.67–0.95; p=0.0121); the risk of CV death and hospitalisation for heart failure by 31% (HR 0.69; 95% CI: 0.57–0.83; p=0.0001); and the risk of hospitalisation for heart failure alone by 39% (HR 0.61; 95% CI 0.47–0.80; p=0.0003).

David Wheeler, Professor of Kidney Medicine at University College, London, says: ‘Kidney disease develops in approximately 40% of people with type 2 diabetes. We have been waiting for new drugs to help us manage these patients for almost 20 years. The exciting results from the CREDENCE study provide renewed optimism for these patients.’

According to Andrea Brown, spokesperson for the National Kidney Federation: ‘Effectively managing chronic kidney disease is a rapidly growing challenge for the NHS and we welcome any research that helps improve the management of this debilitating complication of type 2 diabetes. The exciting research from CREDENCE is the first positive dedicated trial of an antidiabetic agent in this area, showing how under-recognised the irreversible impact of chronic kidney disease and type 2 diabetes has been up until now.’

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