Kidney Week

Abstract: PO0977

Risk of Hospitalization for Heart Failure (HHF) by eGFR and Urinary Albumin-to-Creatinine Ratio (UACR): Pooled Analyses from the CANVAS Program and CREDENCE

Session Information

• Diabetic Kidney Disease: Clinical - 1
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

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

Vlado Perkovic,

• Bakris, George L., Department of Medicine, University of Chicago Medicine, Chicago, Illinois, United States

George L. Bakris,

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

Jaime Blais,

• Cherney, David, University of Toronto, Toronto, Ontario, Canada

David Cherney,

• Damaraju, Cv, Janssen Scientific Affairs, LLC, Titusville, New Jersey, United States

Cv Damaraju,

• Gogate, Jagadish, Janssen Scientific Affairs, LLC, Titusville, New Jersey, United States

Jagadish Gogate,

• L Heerspink, Hiddo Jan, The George Institute for Global Health, Sydney, Australia

Hiddo Jan L Heerspink,

• Kosiborod, Mikhail, The George Institute for Global Health, Sydney, New South Wales, Australia

Mikhail Kosiborod,

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

Kenneth W. Mahaffey,

Background

People with type 2 diabetes (T2D) are at particularly elevated risk of cardiovascular (CV) events including heart failure (HF) if they have chronic kidney disease (CKD). Albuminuria and eGFR are each associated with increased risk, leading to recommendations for annual assessment of these parameters. We analyzed the combined effects of eGFR and UACR on risk of HHF, and the effect of canagliflozin (CANA) on reducing risk, in patients with T2D using pooled data from the CANVAS Program and CREDENCE.

Methods

The CANVAS Program enrolled 10,142 patients with T2D and CV disease or high CV risk. CREDENCE enrolled 4401 patients with T2D and CKD. Risk of HHF was examined in subgroups by baseline eGFR (<45, 45-60, and >60mL/min/1.73m²) and UACR (<30, 30-300, and >300mg/g). Hazard ratios (HR) and 95% CI were estimated using a Cox proportional hazards model.

Results

In placebo-treated participants (Figure), the risk of HHF was generally lowest in people with UACR <30 and eGFR >60, and highest in those with eGFR <45 and UACR >300. HHF rates increased 6.5-fold between those with UACR <30 and >300 and eGFR >60 at baseline and almost 10-fold as eGFR declined from >60 to <45 in patients with UACR <30 at baseline. CANA reduced the risk of HHF overall with some evidence of treatment heterogeneity by UACR and eGFR (P interaction=0.0218).

Conclusion

People with T2D and reduced eGFR, increased albuminuria, and especially both, were at increased risk of HHF. The risk of HHF was reduced overall by CANA.

Funding

• Commercial Support – Janssen Scientific Affairs, LLC