Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

Abstract

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m 2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years.

Publication DOI: https://doi.org/10.1056/NEJMoa1811744
Divisions: College of Health & Life Sciences > School of Biosciences
College of Health & Life Sciences
College of Health & Life Sciences > Chronic and Communicable Conditions
Uncontrolled Keywords: Medicine(all)
Publication ISSN: 1533-4406
Last Modified: 20 May 2024 07:31
Date Deposited: 19 Aug 2019 09:30
Full Text Link:
Related URLs: http://www.nejm ... 6/NEJMoa1811744 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2019-06-13
Accepted Date: 2019-06-01
Authors: Perkovic, Vlado
Jardine, Meg J.
Neal, Bruce
Bompoint, Severine
Heerspink, Hiddo J.l.
Charytan, David M.
Edwards, Robert
Agarwal, Rajiv
Bakris, George
Bull, Scott
Cannon, Christopher P.
Capuano, George
Chu, Pei-ling
De Zeeuw, Dick
Greene, Tom
Levin, Adeera
Pollock, Carol
Wheeler, David C.
Yavin, Yshai
Zhang, Hong
Zinman, Bernard
Meininger, Gary
Brenner, Barry M.
Mahaffey, Kenneth W.
Bellary, Srikanth (ORCID Profile 0000-0002-5924-5278)

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