SGLT2 Inhibitor Could Lower Renal, CVD Risk With Type 2 Diabetes

The sodium-glucose cotransporter 2 (SGLT2) inhibitor canagliflozin lowers the risk of kidney failure and cardiovascular events in patients with type 2 diabetes, according to the results of a recent study.

Although type 2 diabetes is the leading cause of kidney failure, few long-term treatment options for renoprotection in these patients are currently available, according to the study authors. Previous research has suggested that SGLT2 inhibitors could help to improve renal outcomes with type 2 diabetes, although there were some limitations.

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To further explore this relationship, the researchers conducted a double-blind, randomized trial of 4401 patients with type 2 diabetes and albuminuric chronic kidney disease who were randomly assigned to receive either canagliflozin at a dose of 100 mg daily or placebo. All participants had estimated glomerular filtration rates (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and were treated with renin–angiotensin system blockade.

The trial was stopped early following a planned interim analysis. At that time, the relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group (event rates of 43.2 and 61.2 per 1000 patient-years, respectively). The relative risk of the composite of end-stage kidney disease, a doubling of creatinine level, or death from renal causes was lower by 34% (hazard ratio [HR] 0.66) and the relative risk of end-stage kidney disease was lower by 33% (HR 0.68). Risk of cardiovascular death, myocardial infarction, or stroke were also lower in the canagliflozin group (HR 0.80), as was hospitalization for heart failure (HR 0.61).

“These results indicate that canagliflozin may be an effective treatment option for renal and cardiovascular protection in patients with type 2 diabetes with chronic kidney disease,” the researchers concluded.

—Michael Potts

Reference:

Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy [published online April 14, 2019]. NEJM. doi: 10.1056/NEJMoa1811744