The enormity of the need for better treatments for diabetic kidney disease is underscored by the fact that it has been almost 18 years since the last advancement in this area, with the advent of renin-angiotensin-aldosterone system (RAAS) blockers.
It's not surprising, then, that considerable excitement had built up in anticipation of results from the CREDENCE trial, which were presented recently in Melbourne, Australia, at the International Society of Nephrology congress and published simultaneously in the New England Journal of Medicine.[1] This trial shows an unequivocal benefit of canagliflozin in diabetic kidney disease, similar to the straightforward secondary prevention and cardiovascular risk reduction revealed for empagliflozin in the EMPA-REG OUTCOME trial more than 3 years ago.[2]
Although the composite renal endpoint reduction (a post hoc analysis at that time) was a pleasant surprise in EMPA-REG, nephroprotection was subsequently corroborated in the CANVAS program[3] with canagliflozin, and more recently in the DECLARE-TIMI 58 trial[4] with dapagliflozin, albeit as a secondary outcome.
Unequivocal Renal Benefits
Notably, CREDENCE randomly assigned participants to receive canagliflozin or placebo on top of RAAS blocker therapy (as a mandatory study inclusion criterion), and still observed a staggering 30% relative risk reduction in the primary composite outcome of end-stage kidney disease, doubling of serum creatinine, or renal or cardiovascular death.
