Today I'm going to discuss the CREDENCE trial: "Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy."[1] This is a very important trial because it starts shifting us to think about SGLT2 inhibitors as drugs that work to preserve renal function independently of things like glucose lowering or weight reduction. It's also a new way to start thinking about how to treat patients with diabetes and nephropathy.
This was a randomized controlled trial of 4401 patients who had type 2 diabetes and albuminuric chronic kidney disease (CKD). Their albumin-to-creatinine ratios ranged from 300 to 5000, so they were quite albuminuric. All of these individuals were on renin-angiotensin system blockade coming into the trial.
The study participants were randomized to either canagliflozin 100 mg per day or placebo. This is a lower dose of canagliflozin, and it wasn't uptitrated but kept at 100 mg throughout the trial.
To enter the trial, patients had to have an estimated glomerular filtration rate (eGFR) between 30 and 90 mL/min/1.73 m2, but the trial was designed to include 60% of the patients having an eGFR of 30-60. As I mentioned, they all had a significantly elevated albumin-to-creatinine ratio.
The primary outcome was a composite of end-stage renal disease (which was defined as dialysis, transplantation, or a sustained eGFR of less than 15) or a doubling of serum creatinine or death from renal or cardiovascular disease causes.
COMMENTARY
CREDENCE Shifts Our Thinking About SGLT2 Inhibitors
Anne L. Peters, MD
DisclosuresJune 14, 2019
Today I'm going to discuss the CREDENCE trial: "Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy."[1] This is a very important trial because it starts shifting us to think about SGLT2 inhibitors as drugs that work to preserve renal function independently of things like glucose lowering or weight reduction. It's also a new way to start thinking about how to treat patients with diabetes and nephropathy.
This was a randomized controlled trial of 4401 patients who had type 2 diabetes and albuminuric chronic kidney disease (CKD). Their albumin-to-creatinine ratios ranged from 300 to 5000, so they were quite albuminuric. All of these individuals were on renin-angiotensin system blockade coming into the trial.
The study participants were randomized to either canagliflozin 100 mg per day or placebo. This is a lower dose of canagliflozin, and it wasn't uptitrated but kept at 100 mg throughout the trial.
To enter the trial, patients had to have an estimated glomerular filtration rate (eGFR) between 30 and 90 mL/min/1.73 m2, but the trial was designed to include 60% of the patients having an eGFR of 30-60. As I mentioned, they all had a significantly elevated albumin-to-creatinine ratio.
The primary outcome was a composite of end-stage renal disease (which was defined as dialysis, transplantation, or a sustained eGFR of less than 15) or a doubling of serum creatinine or death from renal or cardiovascular disease causes.
Medscape Diabetes © 2019 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Anne L. Peters. CREDENCE Shifts Our Thinking About SGLT2 Inhibitors - Medscape - Jun 14, 2019.
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Authors and Disclosures
Author(s)
Anne L. Peters, MD
Professor, Department of Clinical Medicine, Keck School of Medicine; Director, University of Southern California Westside Center for Diabetes, University of Southern California, Los Angeles, California
Disclosure: Anne L. Peters, MD, has disclosed the following relevant financial relationships:
Serve(d) on the advisory board for: Abbott Diabetes Care; Becton Dickinson; Boehringer Ingelheim Pharmaceuticals, Inc.; Eli Lilly and Company; Lexicon Pharmaceuticals, Inc.; Livongo; Medscape; Merck & Co., Inc.; Novo Nordisk; Omada Health; OptumHealth; sanofi; Zafgen
Received research support from: Dexcom; MannKind Corporation; Astra Zeneca
Serve(d) as a member of a speakers bureau for: Novo Nordisk