CREDENCE - renal benefit with SGLT2i in patients with eGFR <30 ml/min/1.73m²

Last edited 01/2021 and last reviewed 03/2021

• post hoc analysis of the CREDENCE trial (1) suggests that canagliflozin reduced albuminuria and slowed the rate of eGFR decline in patients with eGFR <30 ml/min/1.73m², compared to placebo
• effects of canagliflozin on kidney, CV and mortality outcomes in patients with an eGFR of <30 ml/min/1.73m² were similar to those with an eGFR of >=30 ml/min/1.73m^2
• no detectable increase in harmful effects, including kidney-related adverse events and AKI, with canagliflozin compared with placebo in participants with eGFR <30 ml/min per 1.73 m2
• results support the use and continuation of SGLT2 inhibitor treatment, even in patients with eGFR <30 ml/min per 1.73 m2, until the commencement of maintenance dialysis or receipt of a kidney transplant, and clinicians should consider this when discussing treatment options for patients with low eGFR

The study authors note:

• conclusions that can be drawn from this nonprespecified-subgroup, post hoc analysis should be interpreted cautiously due to the limited statistical precision to robustly assess these outcomes due to the small sample size of this participant group
• there is no reason to discontinue treatment until the commencement of maintenance dialysis or receipt of a kidney transplant, as stipulated in the CREDENCE protocol. Although there may be similar renoprotective effects in people with eGFR <30 ml/min per 1.73 m2, we would not recommend initiating treatment with an SGLT2 inhibitor in people with eGFR <30 ml/min per 1.73 m2 until results of the other pending studies are available

Reference:

• Bakris G, Oshima M, Mahaffey KW, et al. Effects of Canagliflozin in Patients with Baseline eGFR <30 ml/min per 1.73 m². CJASN 2020;15:1705-1714; DOI: 10.2215/CJN.10140620