(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) <30 mL/min/1.73 m2, according to a study published online 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 <30 mL/min/1.73 m2 at randomization. Data were included for 174 of 4401 participants (4%) with eGFR <30 mL/min/1.73 m2.

The researchers observed a 66% difference in the mean rate of eGFR decline from weeks 3 to 130 with canagliflozin versus placebo (mean slopes, –1.30 vs –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).

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“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.


Bakris G, Oshima M, Mahaffey KW, et al. Effects of canagliflozin in patients with baseline eGFR <30 ml/min per 1.73 m2. Clin J Am Soc Nephrol.

Zoungas S and Polkinghorne KR. Are SGLT2 inhibitors safe and effective in advanced diabetic kidney disease? Clin J Am Soc Nephrol. December 2020, 15(12):1694-1695. doi:10.2215/CJN.16351020