New breakthrough treatment for kidney disease offers hope for hundreds of millions of people with diabetes worldwide
Download the CREDENCE trial results presented by Prof Vlado Perkovic at ISNWCN conference (PPT 4 MB)
A new treatment for people with diabetes and kidney disease reduced kidney failure rates by a third, according to a landmark trial.
The results, published in the New England Journal of Medicine, also showed heart failure was reduced by over 30%, and major cardiovascular events by about 20%.
The drug canagliflozin was developed to lower glucose levels for people with diabetes but today has been shown to protect against kidney failure. It also significantly reduced the risk of cardiovascular complications including heart failure, which are common among people with kidney disease.
Around 1.7 million people in Australia have diabetes and up to 40% will go onto develop kidney disease.
Lead author Professor Vlado Perkovic, of The George Institute for Global Health, said there was an urgent need for this new treatment given the surging rates of diabetes.
“Diabetes is the leading cause of kidney failure worldwide but for almost two decades there have been no new treatments to protect kidney function. This definitive trial result is a major medical breakthrough as people with diabetes and kidney disease are at extremely high risk of kidney failure, heart attack, stroke and death. We now have a very effective way to reduce this risk using a once daily pill.”
Researchers say the results, which were presented at the ISN World Congress of Nephrology in Melbourne today, can be implemented immediately as the class of drug is already available.
The study recruited 4,401 patients with diabetes and kidney disease from 34 countries. Half were given canagliflozin on top of best available current care for kidney disease – using either angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The control group received best available care according to current guidelines, and a placebo.
- The number of people developing kidney failure or dying from either kidney failure or cardiovascular disease was reduced by 30%.
- Incidents of hospitalisation for heart failure were reduced by 39%.
- The risk of major cardiovascular outcomes - heart attack, stroke and cardiovascular death - was reduced by 20%.
- There was no increased risk of major side effects.
Co-author Associate Professor Meg Jardine, of The George Institute, said: “What we have shown is that this drug not only protects people with diabetes from developing kidney failure, but it also protects them from heart disease, heart failure and other cardiovascular complications. Importantly, it helps people who already have reduced kidney function and are at particularly high risk.
“With five million people worldwide predicted to have kidney failure by 2035 this is a major breakthrough.”
“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,” said Kenneth Mahaffey, MD, professor of medicine at the Stanford University School of Medicine and co-principal investigator of the trial. “Now, patients with diabetes have a promising option to guard against one of the most severe risks of their condition.”
Nino Bortolussi, a 62-year-old from Sydney who has lived with diabetes for three decades and now only has 20% kidney function, said he hoped the drug would be able to help many other patients with kidney disease. The grandfather from Ermington said: “I have had two heart attacks in the last ten years and I am now unable to walk any real distance. It would have been life-changing if I had had access to a drug that might have prevented not only my heart attacks, but my risk of developing kidney failure.”
The researchers found the drug canagliflozin, a sodium glucose transporter 2 (SGLT2) inhibitor, was less effective at lowering blood sugar in people with reduced kidney function but still led to less kidney failure, heart failure and cardiovascular events such as heart attacks, strokes and death from cardiovascular disease.
Professor Perkovic said the results were impressive. “The substantial benefit on kidney failure despite limited effects on blood glucose suggest that these drugs work in a number of different ways beyond their effects on blood sugar. This is an area of intense ongoing research.”