Canagliflozin Beneficial Even for Advanced Kidney Disease

kidney cross section
kidney cross section
Canagliflozin slows progression of kidney disease in participants with eGFR <30 mL/min/1.73 m2 with no increase in AKI

HealthDay News – Treatment with the sodium glucose cotransporter 2 (SGLT2) inhibitor canagliflozin reduces the rate of kidney disease progression among participants with an estimated glomerular filtration rate (eGRF) less than 30mL/min/1.73m2, according to a study published online November 19 in the Clinical Journal of the American Society of Nephrology.

George Bakris, MD, from the University of Chicago Medicine, and colleagues conducted a post-hoc analysis to examine the impact of canagliflozin among CREDENCE trial participants with eGRF less than 30mL/min/1.73m2 at randomization. Data were included for 174 of 4401 participants (4%) with eGFR less than 30mL/min/1.73m2.

The researchers observed a 66% difference in the mean rate of eGFR decline from weeks 3 to 130 with canagliflozin vs placebo (mean slopes, –1.30 vs –3.83mL/min/1.73m2/year). For those with less than 30 and greater than or equal to 30 mL/min/1.73 m2, the effects of canagliflozin were consistent on kidney, cardiovascular, and mortality outcomes (all P interaction greater than 0.20). The estimate for kidney failure was similar for participants with eGFR less than 30 and greater than or equal to 30 mL/min/1.73m2 (P =.80). The rate of kidney-related adverse events or acute kidney injury associated with canagliflozin was not imbalanced between participants with eGFR less than 30 and greater than or equal to 30 mL/min/1.73 m2 (P >.12).

“These results support the use and continuation of SGLT2 inhibitor treatment even in patients with eGFR less than 30mL/min/1.73m2 until the commencement of maintenance dialysis or receipt of a kidney transplant, and clinicians should consider this when discussing treatment options for patients with low eGFR,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Janssen Research & Development, which sponsored the CREDENCE trial and developed canagliflozin in collaboration with Mitsubishi Tanabe Pharma Corporation.

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