Breakthrough kidney disease treatment offers hope for hundreds of millions with diabetes worldwide
17 April 2019
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.
The results, published in the New England Journal of Medicine, also showed heart failure was reduced by over 30 per cent, and major cardiovascular events by about 20 per cent.
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 on Monday 15 April, can be implemented immediately as the 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 according to current guidelines, using either angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The control group received best available care, and a placebo.
- The number of people developing kidney failure or dying from either kidney failure or cardiovascular disease was reduced by 30 per cent.
- Incidents of hospitalisation for heart failure were reduced by 39 per cent.
- 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, says, "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," added 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."
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."