The study included 4,401 patients, ages 30 and older, with type 2 diabetes and chronic kidney disease. These patients were randomized to take either canagliflozin or a placebo at 690 locations in 34 countries from March 2014 to May 2017.
They were monitored at 3, 13 and 26 weeks, during which the effects of the drug appeared to be monitored.
The researchers found that in the canagliflozin group the renal relative risk of death was 34% lower and the relative risk of end-stage renal disease was 32% lower. The group also had a lower risk of cardiovascular death, myocardial infarction, stroke and hospitalization for heart failure.
Based on data in the study, the researchers estimated that treatment with canagliflozin 22 would prevent hospital admissions for heart failure and 25 composite events of cardiovascular disease death, heart attack or stroke in 1
The study had some limitations, including that patients who had a very advanced kidney disease were not included. Patients believed to be affected by kidney disease other than type 2 diabetes were also excluded. To determine if the study's results could be generalized to other types of kidney disease, more research is needed.
"With this whole class of medications, we really need to think about how we use it, because of the cardio-renal benefits," says Molitch id about SGLT2 inhibitors.
"This class of drugs really affects the kidney from a diabetes perspective. Usually we have a lot of glucose – the main sugar that circulates in the blood – and then the kidney filters that glucose. That's why most of the time there is no glucose in the urine, because the kidney reabsorbs all the glucose that is filtered out of the blood, "he said. "What these medications do is they hold back this reabsorption of glucose from the urine into the blood, and so you excrete lots of glucose into the urine."
"We still are not entirely sure what mechanisms cause these heart and kidney effects, but they are clearly not just because of lowering blood sugar levels," he said.
"The benefit to the heart and kidney occurs in patients with advanced kidney disease who have a minimal effect on the blood sugar lowering effect of canagliflozin," he said. "Based on this study, we could only use canagliflozin for kidney and possibly cardiac benefits, while keeping other glucose levels under control in patients with diabetes and kidney disease."
"This study was conceived for people with diabetic kidney disease and is thus the first example of a reduction in the risk of renal failure [as] and improved cardiovascular outcomes," said Leroith, who was not involved in the study. "I believe that the paper is of great importance and will have a broad readership with a big impact."