CREDENCE: Acute drops in eGFR with canagliflozin initiation may not be cause for concern
medwireNews: A post-hoc analysis of data from the CREDENCE trial suggests that transient drops in estimated glomerular filtration rate (eGFR) occur in almost half of canagliflozin-treated patients and are not associated with an increased risk for adverse outcomes.
In the study of 4289 patients with type 2 diabetes and chronic kidney disease who had available eGFR measurements, those treated with the sodium-glucose cotransporter (SGLT)2 inhibitor were significantly more likely than those given placebo to experience an acute decrease in eGFR of more than 10%, at rates of 45% and 21%, respectively. This elevated risk was seen across different subgroups, including when patients were categorized by age, sex, race, blood pressure, and history of heart failure.
Speaking at the virtual ADA 80th Scientific Sessions, the presenter said that “the benefit of canagliflozin compared to placebo [occurred] regardless of the acute eGFR decline.” Long-term trajectories of eGFR were comparable among patients with an acute decrease of more than 10%, an acute decrease of 0–10%, or an acute increase in eGFR.
Moreover, adverse event profiles were “consistent” irrespective of whether participants experienced an initial drop in eGFR, added Hiddo Heerspink (University Medical Center Groningen, the Netherlands).
“Considering the beneficial effects of canagliflozin in this population, our data suggest that an acute drop in eGFR of no more than 30% following canagliflozin initiation may be no reason for safety concern,” he concluded.
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