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Abstract: TH-OR040

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

Session Information

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
  • Ohkuma, Toshiaki, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
  • Neal, Bruce, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
  • Matthews, David R., Oxford Centre for Diabetes, Endocrinology and Metabolism and Harris Manchester College, University of Oxford, Oxford, United Kingdom
  • de Zeeuw, Dick, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  • Mahaffey, Kenneth W., Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
  • Fulcher, Greg, Royal North Shore Hospital, Sydney, New South Wales, Australia
  • Blais, Jaime, Janssen Scientific Affairs, LLC, Titusville, New Jersey, United States
  • Li, Qiang, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
  • Jardine, Meg J., The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
  • Wheeler, David C., Centre for Nephrology, University College London, London, United Kingdom
  • Perkovic, Vlado, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
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