For nearly two decades, doctors have relied on one treatment to try to avert kidney failure in patients with Type 2 diabetes and kidney disease.
That's why it's encouraging to see that new results from a large, multi-center clinical trial promise to improve on that treatment.
The CREDENCE trial found that the drug canagliflozin, used along with current best available care, lowers the risk of kidney failure by a third for patients with Type 2 diabetes and kidney disease. It also reduced risk of hospitalization for heart failure or death due to cardiac causes.
The findings appear in The New England Journal of Medicine and were presented at the World Congress of Nephrology in Australia. Kenneth Mahaffey, MD, director of the Stanford Center for Clinical Research, is the study's senior author and co-principal investigator of CREDENCE, which stands for Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation.
An editorial in NEJM discusses the significance of the results, noting: "Overall, the importance of CREDENCE, a well done and large clinical trial, cannot be overstated."
Our news release explained:
People with diabetes can develop kidney disease because prolonged high blood sugar harms blood vessels in the kidney. In addition, diabetes often causes high blood pressure, which can stretch and weaken blood vessels in the organ.
The therapy used for the past 18 years to prevent deterioration of kidney function in diabetic patients succeeded in lowering blood pressure and delaying progression of kidney disease. However, patients undergoing this treatment remained at high risk for renal failure and cardiovascular disease, as well as death from those conditions.
Canagliflozin has already been approved by the U.S. Food and Drug Administration for other uses for patients with diabetes. The CREDENCE trial sought to assess the drug's effects on kidney health in patients with Type 2 diabetes and kidney disease. In the trial, about 4,400 patients in 34 countries received the current standard treatment. Additionally, half of them were randomly selected to receive canagliflozin, and the other half were given a placebo. As I wrote in the release:
The primary results of the study found that participants who took canagliflozin were 30 percent less likely than the placebo group to develop kidney failure or die from either renal failure or cardiovascular disease. Their risk of kidney failure or death from kidney failure was reduced by 34 percent, and the risk of hospitalization for heart failure or death due to cardiac causes decreased by 31 percent.
Both Mahaffey and lead author Vlado Perkovic, MBBS, PhD, hailed the potential of the new therapy.
"A drug like canagliflozin that improves both cardiovascular and renal outcomes has been eagerly sought by both patients with Type 2 diabetes and clinicians caring for them," Mahaffey said.
Perkovic, executive director of The George Institute for Global Health Australia and a professor of medicine at the University of New South Wales in Sydney, added:
People with diabetes and kidney disease are at extremely high risk of kidney failure, heart attack, stroke and death... With this definitive trial result, we now have a very effective way to reduce this risk using a once-daily pill.
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