An overriding goal in medicine is to decrease variability in the way chronic disease is treated. Clinical research can have important implications in defining the latest standards of care, so we make every effort to keep our clinicians up to date on the most current research findings. One recent study shows promising results for the treatment of end-stage renal disease.
In April 2019, the New England Journal of Medicine published the outcomes of the CREDENCE trial (Canigloflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy). Its primary outcome measure was a composite of end-stage renal disease, a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Patients were randomized to receive canigloflozin 100 mg daily or placebo.
In the study, 4401 patients were followed for an average of 2.62 years. The trial actually was stopped early based on successful outcomes with canigloflozin. The relative risk of the primary outcome was 30 percent lower in the canigloflozin group. The relative risk of end-stage renal disease was reduced by 32 percent as well.
This could prove to be a landmark study in the treatment of diabetic nephropathy with SGLT2 inhibitors for risk reduction in end-stage renal disease, one of the most costly conditions that patients in our cohort will face. The SGLT2 inhibitors should be monitored for their adverse effects, including dehydration, worsening of renal function, and infections, which have been reported. Further breakdown of the secondary end points of this study will be forthcoming and may show some added benefits to this group of agents for diabetes control.
– James J. Matera DO, FACOI