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397. Abstract 14752: Canagliflozin Reduces Cardiovascular and Renal Events in Patients With Type 2 Diabetes and Chronic Kidney Disease Regardless of Baseline HbA1c, Including Those With HbA1c <7%: Results From the CREDENCE Trial

Author

Cannon, Christopher P, Perkovic, Vlado, Agarwal, Rajiv, Baldassarre, James, Bakris, George L, Brenner, Barry M, Charytan, David, de Zeeuw, Dick, Edwards, Robert, Greene, Tom, Lambers Heerspink, Hiddo J, Jardine, Meg, Levin, Adeera, Li, Jing-Wei, Neal, Bruce, Pollock, Carol, Wheeler, David, Zhang, Hong, Zinman, Bernard, and Mahaffey, Kenneth W

Abstract

Background:SGLT2 inhibitors have to date been recommended as add-on therapy for patients whose HbA1c is not at goal, typically >7%, based on the initial clinical trials. We sought to determine if the renal and cardiovascular (CV) benefits of this class of drugs differ according to baseline HbA1c.Methods:CREDENCE was a double-blind, randomized trial of canagliflozin 100 mg versus placebo in 4401 patients with type 2 diabetes and chronic kidney disease (CKD). Approximately half had prior atherosclerotic CV disease (ASCVD). Overall, canagliflozin significantly reduced the primary renal outcome (end-stage kidney disease [ESKD], doubling of serum creatinine, or renal or CV death), ESKD, CV death, hospitalization for heart failure, and MACE (major adverse CV events: CV death, nonfatal myocardial infarction, or nonfatal stroke). We analyzed CV, renal, and safety outcomes by baseline HbA1c <7% (N=650), 7 to <8% (N=1406) and ?8% (N=2343), and results are reported without adjustment for multiplicity.Results:Across categories of baseline HbA1c levels, treatment with canagliflozin resulted in similar risk reductions in the primary renal outcome, CV death, hospitalization for heart failure, and MACE (P interaction = NS for all; Figure). Similarly, across baseline HbA1c categories, including in participants with HbA1c <7%, there were no differences in the risk of serious adverse events or other safety events.Conclusions:Canagliflozin reduced the risk of both kidney failure and CV events in patients with type 2 diabetes and CKD irrespective of baseline HbA1c, including in patients with baseline HbA1c <7%, suggesting that treatment of patients with CKD and/or ASCVD is warranted, even if their diabetes is ?well controlled.?

Published
2019
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398. Preface

Author

Clarkson, Michael R., Magee, Ciara N., and Brenner, Barry M.

Published
2010
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