Canagliflozin May Reduce Anemia Risk in Diabetic CKD

In the CREDENCE trial, patients receiving canagliflozin had reduced risks of initiating iron therapy and erythropoiesis-stimulating agents compared with patients receiving placebo.

In addition to its ability to reduce glucose and blood pressure, canagliflozin might reduce the risk for the development of anemia and initiation of anemia treatments in patients who have type 2 diabetes and chronic kidney disease, new study findings indicate.

In a post hoc analysis of the CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial, canagliflozin treatment was associated with a greater mean hemoglobin increase of 7.1g/L and a greater hematocrit increase of 2.4% compared with placebo during a median 2.6 years.

Further, the risk for a composite outcome of anemia events or anemia treatment was a significant 35% lower among patients receiving canagliflozin, a sodium glucose cotransporter 2 inhibitor, compared with placebo, Hiddo Lambers Heerspink, PhD, of the University Medical Center Groningen in Groningen, the Netherlands, and colleagues reported in The Lancet: Diabetes & Endocrinology. The canagliflozin group also had significant 42%, 36%, and 35% lower risks for anemia events alone, initiation of iron therapy, and need for erythropoiesis-stimulating agents (ESA), respectively, compared with the placebo arm, the investigators reported.

At baseline, 1599 (36%) of all 4401 patients had anemia (hemoglobin less than 130g/L in men or less than 120g/L in women), and 33 patients (less than 1%) used ESAs. During follow-up, 573 patients had an investigator-reported anemia event or initiated anemia treatment, of whom 358 (8%) had anemia events, 343 (8%) initiated iron preparations, 141 (3%) initiated ESAs, and 114 (2%) received blood transfusions.

“In addition to the benefits for kidney and cardiovascular outcomes, the available evidence suggests that canagliflozin might reduce the risk of anaemia and minimise the need for erythropoiesis-stimulating agents and other treatments for anaemia in patients with type 2 diabetes and chronic kidney disease,” Dr Heerspink’s team concluded.

As this study was post hoc and anemia was not a prepecified endpoint, prospective research is needed to confirm the findings.

Disclosure: This clinical trial was supported by Janssen Research and Development. Please see the original reference for a full list of authors’ disclosures.


Oshima M, Neuen BL, Jardine MJ, et al. Effects of canagliflozin on anaemia in patients with type 2 diabetes and chronic kidney disease: a post-hoc analysis from the CREDENCE trial. Lancet Diabetes Endocrinol. 2020;8:903-914. doi:10.1016/S2213-8587(20)30300-4

This article originally appeared on Renal and Urology News