Early Change in Albuminuria with Canagliflozin Predicts Kidney and Cardiovascular Outcomes: A
Aged
Albuminuria
/ diagnosis
Canagliflozin
/ therapeutic use
Cardiovascular Diseases
/ diagnosis
Diabetes Mellitus, Type 2
/ complications
Diabetic Nephropathies
/ diagnosis
Double-Blind Method
Female
Hospitalization
Humans
Male
Middle Aged
Renal Insufficiency, Chronic
/ diagnosis
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
SGLT2 inhibitor
albuminuria
canagliflozin
kidney and cardiovascular outcomes
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
24
05
2020
accepted:
11
08
2020
pubmed:
2
10
2020
medline:
13
3
2021
entrez:
1
10
2020
Statut:
ppublish
Résumé
The association between early changes in albuminuria and kidney and cardiovascular events is primarily based on trials of renin-angiotensin system blockade. It is unclear whether this association occurs with sodium-glucose cotransporter 2 inhibition. The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial enrolled 4401 patients with type 2 diabetes and CKD (urinary albumin-creatinine ratio [UACR] >300 mg/g). This Complete data for early change in albuminuria and other covariates were available for 3836 (87.2%) participants in the CREDENCE trial. Compared with placebo, canagliflozin lowered UACR by 31% (95% confidence interval [95% CI], 27% to 36%) at week 26, and significantly increased the likelihood of achieving a 30% reduction in UACR (odds ratio, 2.69; 95% CI, 2.35 to 3.07). Each 30% decrease in UACR over the first 26 weeks was independently associated with a lower hazard for the primary kidney outcome (hazard ratio [HR], 0.71; 95% CI, 0.67 to 0.76; In people with type 2 diabetes and CKD, use of canagliflozin results in early, sustained reductions in albuminuria, which were independently associated with long-term kidney and cardiovascular outcomes.
Sections du résumé
BACKGROUND
The association between early changes in albuminuria and kidney and cardiovascular events is primarily based on trials of renin-angiotensin system blockade. It is unclear whether this association occurs with sodium-glucose cotransporter 2 inhibition.
METHODS
The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial enrolled 4401 patients with type 2 diabetes and CKD (urinary albumin-creatinine ratio [UACR] >300 mg/g). This
RESULTS
Complete data for early change in albuminuria and other covariates were available for 3836 (87.2%) participants in the CREDENCE trial. Compared with placebo, canagliflozin lowered UACR by 31% (95% confidence interval [95% CI], 27% to 36%) at week 26, and significantly increased the likelihood of achieving a 30% reduction in UACR (odds ratio, 2.69; 95% CI, 2.35 to 3.07). Each 30% decrease in UACR over the first 26 weeks was independently associated with a lower hazard for the primary kidney outcome (hazard ratio [HR], 0.71; 95% CI, 0.67 to 0.76;
CONCLUSIONS
In people with type 2 diabetes and CKD, use of canagliflozin results in early, sustained reductions in albuminuria, which were independently associated with long-term kidney and cardiovascular outcomes.
Identifiants
pubmed: 32998938
pii: ASN.2020050723
doi: 10.1681/ASN.2020050723
pmc: PMC7790219
doi:
Substances chimiques
Sodium-Glucose Transporter 2 Inhibitors
0
Canagliflozin
0SAC974Z85
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2925-2936Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
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