Kidney Week

Abstract: SA-PO1147

Efficacy and Safety of Canagliflozin in Patients with Persistent Drop in eGFR Below 30 mL/min per 1.73 m2: Insights from the CREDENCE Clinical Trial

Session Information

• CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Mavrakanas, Thomas A., Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

Thomas A. Mavrakanas, MD, MS, FASN

• Elenjickal, Elias John, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

Elias John Elenjickal, MD

• Sharma, Abhinav, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

Abhinav Sharma, DrMed, PhD

• Baroz, Frederic, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

Frederic Baroz

Background

The CREDENCE clinical trial randomized patients with type 2 diabetes and chronic kidney disease (CKD) to receive canagliflozin 100 mg daily or matching placebo. Patients with progressive decline in renal function were allowed to stay on the study medication until dialysis initiation. Clinical outcomes in patients with a persistent drop in eGFR below 30 ml/min/1.73m² have not yet been reported.

Methods

This is a post-hoc analysis from the CREDENCE clinical trial. Patients with persistent drop in eGFR below 30 ml/min/1.73m² were followed from the time point they progressed to stage IV CKD until the end of the study (N=597). The primary outcome was CKD progression, defined as doubling of serum creatinine, progression to kidney failure, or renal death. Secondary outcomes included cardiovascular endpoints, all-cause mortality, and safety outcomes. Inverse probability weighted Cox proportional hazard regression was used.

Results

Baseline characteristics were similar in both study arms. The incidence of CKD progression was lower with canagliflozin, compared with placebo: 17.2 vs. 25.2 events per 100 patient-years, hazard ratio (HR) 0.70 (95% confidence interval (CI) 0.50-0.99, p=0.04) (Figure). There was no difference in the incidence of cardiovascular outcomes and all-cause mortality between the study groups. The incidence of acute kidney injury and hyperkalemia was low in both study arms with no significant difference between patients treated with canagliflozin or placebo (Figure).

Conclusion

The benefit from canagliflozin on CKD progression was sustained in patients with persistent GFR decline below 30 ml/min/1.73m². No safety signal was detected in this population.

Figure. Clinical outcomes in patients with persistent GFR decline <30 ml/min/1.73m².

Funding

• Private Foundation Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025dcskpv49