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Canagliflozin Beneficial Even for Advanced Kidney Disease

MONDAY, Nov. 30, 2020 -- 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) <30 mL/min/1.73 m², according to a study published online Nov. 19 in the Clinical Journal of the American Society of Nephrology.

George Bakris, M.D., 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 <30 mL/min/1.73 m² at randomization. Data were included for 174 of 4,401 participants (4 percent) with eGFR <30 mL/min/1.73 m².

The researchers observed a 66 percent difference in the mean rate of eGFR decline from weeks 3 to 130 with canagliflozin versus placebo (mean slopes, –1.30 versus –3.83 mL/min/1.73 m²/year). For those with <30 and ≥30 mL/min/1.73 m², the effects of canagliflozin were consistent on kidney, cardiovascular, and mortality outcomes (all P interaction > 0.20). The estimate for kidney failure was similar for participants with eGFR <30 and ≥30 mL/min/1.73 m² (P interaction = 0.80). The rate of kidney-related adverse events or acute kidney injury associated with canagliflozin was not imbalanced between participants with eGFR <30 and ≥30 mL/min/1.73 m² (P interaction > 0.12).

"These results support the use and continuation of SGLT2 inhibitor treatment even in patients with eGFR <30 mL/min/1.73 m² 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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Posted: November 2020