Kidney Week

Abstract: TH-OR040

Effect of Canagliflozin on Cardiovascular and Renal Outcomes across KDIGO Risk Categories: Analysis from the CANVAS Program

Session Information

• Diabetic Kidney Disease Trials: Progress Being Made
  October 25, 2018 | Location: 5A, San Diego Convention Center
  Abstract Time: 06:18 PM - 06:30 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Neuen, Brendon Lange, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Brendon Lange Neuen, MBBS

• Ohkuma, Toshiaki, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Toshiaki Ohkuma,

• Neal, Bruce, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Bruce Neal,

• Matthews, David R., Oxford Centre for Diabetes, Endocrinology and Metabolism and Harris Manchester College, University of Oxford, Oxford, United Kingdom

David R. Matthews,

• de Zeeuw, Dick, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Dick de Zeeuw,

• Mahaffey, Kenneth W., Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States

Kenneth W. Mahaffey,

• Fulcher, Greg, Royal North Shore Hospital, Sydney, New South Wales, Australia

Greg Fulcher,

• Blais, Jaime, Janssen Scientific Affairs, LLC, Titusville, New Jersey, United States

Jaime Blais,

• Li, Qiang, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Qiang Li,

• Jardine, Meg J., The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Meg J. Jardine,

• Wheeler, David C., Centre for Nephrology, University College London, London, United Kingdom

David C. Wheeler,

• Perkovic, Vlado, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Vlado Perkovic,

Background

The CANagliflozin cardioVascular Assessment Study (CANVAS) Program randomized patients with type 2 diabetes to canagliflozin or placebo and demonstrated that the drug reduced the risk of cardiovascular (CV) and renal outcomes. The Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease classification is a risk stratification tool based on estimated glomerular filtration rate (eGFR, mL/min/1.73 m²) and urinary albumin:creatinine ratio (UACR, mg/g).

Methods

Absolute effects on CV and renal outcomes were analyzed by baseline KDIGO risk category, defined as low risk (eGFR ≥60 and UACR <30), moderate risk (eGFR 45-<60 and UACR <30, or eGFR ≥60 and UACR 30-300), high risk (eGFR 30-<45 and UACR <30, eGFR 45-<60 and UACR 30-300, or eGFR ≥60 and UACR >300), and very high risk (eGFR <30 with any UACR, eGFR 30-<45 and UACR ≥30, or eGFR 45-<60 and UACR >300).

Results

Of 10,142 participants, 10,031 (98.9%) had available baseline eGFR and UACR data. The proportion of participants in low, moderate, high, and very high risk categories was 58.6%, 25.8%, 10.6%, and 5.0%, respectively. Heterogeneity in absolute effects across KDIGO risk categories was observed for the primary outcome (CV death, nonfatal myocardial infarction, or nonfatal stroke; P heterogeneity=0.023), hospitalization for heart failure (P=0.047), and the renal composite outcome (40% decrease in eGFR, end-stage kidney disease, or renal death; P=0.001; Figure).

Conclusion

The absolute reduction in CV and renal outcomes with canagliflozin may be greater in patients at higher renal risk.

Funding

• Commercial Support –