A new treatment for people with diabetes and kidney disease reduced kidney failure rates by a third, according to a landmark study, and delivered dramatic findings relating to heart disease.
The results, published in the New England Journal of Medicine, also showed heart failure was reduced by more than 30 per cent and major cardiovascular problems by about 20 per cent.
The drug, canagliflozin, was developed to lower glucose levels in people with diabetes, but has also proven to protect against kidney failure, and significantly reduced the risk of cardiovascular complications, including heart failure, which are common among people with kidney disease.
Around 500 million people worldwide have diabetes and up to 40 per cent will develop kidney disease.
Lead author Professor Vlado Perkovic, of The George Institute for Global Health, said there was an urgent need for the 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,” he said. “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, can be implemented immediately, as the drug is already available.
The study recruited 4401 patients from 34 countries. All had diabetes and kidney disease. Half were given canagliflozin on top of best available current care for kidney disease – using either angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The control group received best available care according to current guidelines, and a placebo.
The research found:
- The number of people developing kidney failure or dying from either renal failure or cardiovascular disease was reduced by 30 per cent.
- Hospitalisation for heart failure was reduced by 39 per cent.
- The risk of major cardiovascular outcomes – (heart attack, stroke and cardiovascular death) was reduced by 20 per cent.
- There was no increased risk of major side effects.
Co-author Associate Professor Meg Jardine, of The George Institute, said: “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 5 million people predicted to have kidney failure by 2035, this is a major breakthrough.”
Kenneth Mahaffey, MD, professor of medicine at the Stanford University School of Medicine and co-principal investigator of the trial said: “A drug like canagliflozin, which improves both cardiovascular and renal outcomes, has been eagerly sought by both patients with Type 2 diabetes and clinicians caring for them. 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 fewer incidents of kidney failure, heart failure and cardiovascular problems.
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