WASHINGTON—Canagliflozin showed a protective effect against kidney function decline in patients with type 2 diabetes and a baseline estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2, new study findings presented at the American Society of Nephrology’s Kidney Week 2019 meeting suggest.
The findings are from a post-hoc subgroup analysis of the phase 3 CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial, which demonstrated that canagliflozin, a sodium glucose co-transporter 2 inhibitor, significantly decreased the risk of kidney failure and cardiovascular events in patients with chronic kidney disease and type 2 diabetes. In the double-blind trial, investigators randomly assigned patients with an eGFR (in mL/min/1.73 m2) of 30 or higher but less than 90 to receive canagliflozin or placebo.
The post-hoc analysis, led by George Bakris, MD, of University of Chicago Medicine, included 174 patients whose eGFR had been 30 or higher at the time of screening but fell below 30 at the time of randomization. Canagliflozin decreased the rate of eGFR decline compared with placebo. From week 3 to the last measurement, the investigators observed a 43% decrease in the rate of eGFR decline with canagliflozin compared with placebo (-1.30 vs -2.83). Compared with placebo recipients, canagliflozin-treated patients had a 33% decreased risk of end-stage renal disease (ESRD). In the study population as a whole, canagliflozin-treated patients experienced a 32% decreased risk of ESRD.
Canagliflozin had beneficial effects with regard to most cardiovascular and mortality outcomes in the overall population. These effects appeared to be consistent among patients with an eGFR below 30, but the differences between the canagliflozin and placebo groups were not statistically significant, Dr Bakris and his colleagues reported.
“In this subgroup of people with an eGFR of 26, the renal protection and cardiovascular protection are consistent with what we saw in the overall trial,” Dr Bakris told Renal & Urology News.
The investigators observed no clinically meaningful difference in HbA1c between canagliflozin and placebo over the course of the study. The safety profile in the subgroup analysis was similar to that of the overall study population.
Bakris G, OshimA M, Mahaffey KW, et al. Canagliflozin slows declines in kidney function in people with baseline <eGFR 30 mL/min/1.73 m2. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10 in Washington, DC. Poster TH-PO1202.