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
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