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Management of Coronary Disease in Patients with Advanced Kidney Disease
BACKGROUND:Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS:We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS:At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P = 0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P = 0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P = 0.03). CONCLUSIONS:Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).
PMID: 32227756
ISSN: 1533-4406
CID: 5451232
SAT-156 RENAL, CARDIOVASCULAR, AND SAFETY OUTCOMES OF CANAGLIFLOZIN ACCORDING TO BASELINE ALBUMINURIA: A CREDENCE SECONDARY ANALYSIS [Meeting Abstract]
Introduction: Albuminuria is a strong risk factor for kidney disease progression and cardiovascular disease as reflected in the KDIGO categories of urinary ACR <30mg/g, 30-300 and >300 mg/g. The CREDENCE trial recruited participants with substantial levels of albuminuria. We examined the relative and absolute effects of canagliflozin according to baseline albuminuria among people in the CREDENCE trial.
Method(s): The CREDENCE double-blind randomised study of 4401 participants with eGFR 30-<90mL/min/1.73m2 and urinary albumin:creatinine ratio [uACR]>300-5000mg/g, demonstrated that canagliflozin significantly reduced renal and cardiovascular outcomes including the primary composite of end-stage kidney disease, doubling serum creatinine, or renal or cardiovascular death. We analysed the effect of canagliflozin on these and renal safety outcomes according to categories of baseline uACR of <=1000, >1000-<3000 and >=3000mg/g.
Result(s): At baseline, 2348 (53.4%), 1547 (35.2%), and 506 (11.5%) participants had uACR <=1000, >1000-<3000, >=3000mg/g, respectively. Higher categories of uACR were associated with higher rates of events (Figure). Canagliflozin reduced renal and cardiovascular endpoints, with no statistical evidence the effect varied in different uACR groups (all p heterogeneity >0.17). Canagliflozin led to a greater absolute reduction in renal events in those with higher grades of uACR (number needed to treat [NTT] to prevent one episode of the primary composite: 22 and 8 for uACR >1000-<3000 and >=3000mg/g, respectively). Rates of renal-related adverse events were lower overall with canagliflozin, with greater relative reduction greater in higher grades of uACR (p heterogeneity=0.003). Canagliflozin had no significant effect on the individual events of acute kidney injury, volume depletion, hyperkalaemia, urinary tract infections or hypoglycaemia, with no differences among grades of uACR (all p heterogeneity >0.12).
Conclusion(s): Albuminuria predicts renal and cardiovascular risk at high levels of albuminuria. Canagliflozin safely reduces renal and cardiovascular events in people with type 2 diabetes and substantial albuminuria, with the greatest absolute renal benefit in those with albuminuria of 3000-5000mg/g. [Formula presented]
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Method(s): The CREDENCE double-blind randomised study of 4401 participants with eGFR 30-<90mL/min/1.73m2 and urinary albumin:creatinine ratio [uACR]>300-5000mg/g, demonstrated that canagliflozin significantly reduced renal and cardiovascular outcomes including the primary composite of end-stage kidney disease, doubling serum creatinine, or renal or cardiovascular death. We analysed the effect of canagliflozin on these and renal safety outcomes according to categories of baseline uACR of <=1000, >1000-<3000 and >=3000mg/g.
Result(s): At baseline, 2348 (53.4%), 1547 (35.2%), and 506 (11.5%) participants had uACR <=1000, >1000-<3000, >=3000mg/g, respectively. Higher categories of uACR were associated with higher rates of events (Figure). Canagliflozin reduced renal and cardiovascular endpoints, with no statistical evidence the effect varied in different uACR groups (all p heterogeneity >0.17). Canagliflozin led to a greater absolute reduction in renal events in those with higher grades of uACR (number needed to treat [NTT] to prevent one episode of the primary composite: 22 and 8 for uACR >1000-<3000 and >=3000mg/g, respectively). Rates of renal-related adverse events were lower overall with canagliflozin, with greater relative reduction greater in higher grades of uACR (p heterogeneity=0.003). Canagliflozin had no significant effect on the individual events of acute kidney injury, volume depletion, hyperkalaemia, urinary tract infections or hypoglycaemia, with no differences among grades of uACR (all p heterogeneity >0.12).
Conclusion(s): Albuminuria predicts renal and cardiovascular risk at high levels of albuminuria. Canagliflozin safely reduces renal and cardiovascular events in people with type 2 diabetes and substantial albuminuria, with the greatest absolute renal benefit in those with albuminuria of 3000-5000mg/g. [Formula presented]
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EMBASE:2005255770
ISSN: 2468-0249
CID: 4359542
Accelerated Venovenous Hemofiltration as a Transitional Renal Replacement Therapy in the Intensive Care Unit
BACKGROUND:Continuous renal replacement therapy (CRRT) is commonly employed in the intensive care unit (ICU), though there are no guidelines around the transition between CRRT and intermittent hemodialysis (iHD). Accelerated venovenous hemofiltration (AVVH) is a modality utilizing higher hemofiltration rates (4-5 L/h) with shorter session durations (8-10 h) to "accelerate" the clearance and volume removal that normally is spread out over a 24-h period in CRRT. We examined AVVH as a transition therapy between CRRT and iHD, with the aim of decreasing time on CRRT and providing a more graduated transition for hemodynamically unstable patients requiring RRT. METHODS:Retrospective cohort study describing the clinical outcomes and quality initiative experience of the integration of AVVH into the CRRT program at an academic tertiary care center. Outcomes of interest included mortality, ICU length of stay and readmission rates, and technical characteristics of treatments. RESULTS:In total, 97 patients received a total of 298 AVVH treatments (3.1 ± 3.3 treatments per patient). Totally, 271/298 (91%) treatments were completed successfully. During an average treatment time of 9.5 ± 1.6 h with 4.2 ± 0.5 L/h -replacement fluid rate, urea reduction ratio was 23 ± 26% per 10-h treatment, and net ultrafiltration volume was 2.4 ± 1.3 L/treatment. Inpatient mortality was 32%, mean total hospital length of stay was 54 ± 47 days. Sixty-four out of 97 (66%) patients recovered renal function by discharge. Among those who transferred out of the ICU, 7/62 (11%) patients required readmission to the ICU after developing hypotension on iHD. CONCLUSION/CONCLUSIONS:AVVH can serve as a transition therapy between CRRT and iHD in the ICU and has the potential to decrease total time on CRRT, improve patient mobility, and sustain low ICU readmission rates. Future study is needed to analyze the implications on resource use and cost of this modality.
PMID: 32097936
ISSN: 1421-9670
CID: 4324302
Evaluating the Effects of Canagliflozin on Cardiovascular and Renal Events in Patients with Type 2 Diabetes and Chronic Kidney Disease According to Baseline HbA1c, Including Those with HbA1c <7%: Results From the CREDENCE Trial
Traditional management of diabetes mellitus has focused on glycemic control, beginning with lifestyle changes, followed by metformin, and then other classes of antiglycemic agents.1 Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce cardiovascular (CV) events, including CV death, myocardial infarction (MI) and heart failure, and slow progression of renal dysfunction, including prevention of end-stage kidney disease (ESKD).2-3 Because initial clinical trials included mostly patients with baseline HbA1c >7%, current guidelines have recommended this class as add-on therapy for patients whose HbA1c is not at goal, typically ≥7%.1 We hypothesized that there would be similar benefits on CV and renal endpoints regardless of baseline HbA1c, including those with HbA1c <7%.
PMID: 31707795
ISSN: 1524-4539
CID: 4186692
Coronary Microvascular Dysfunction, Left Ventricular Remodeling and Clinical Outcomes in Patients with Chronic Kidney Impairment
Background: Cardiac dysfunction and cardiovascular (CV) events are prevalent among patients with chronic kidney disease (CKD) without overt obstructive coronary artery disease (CAD) but the mechanisms remain poorly understood. Coronary microvascular dysfunction (CMD) has been proposed as a link between abnormal renal function and impairment of cardiac function and CV events. We sought to investigate the relationships between CKD, CMD, cardiac dysfunction and adverse CV outcomes. Methods: Patients undergoing cardiac stress positron emission tomography (PET), echocardiogram and renal function ascertainment at Brigham and Women's Hospital were studied longitudinally. Patients free of overt coronary (summed stress score < 3 & without history of ischemic heart disease), valvular and end-organ disease were followed for adverse composite outcome of death, hospitalization for myocardial infarction or heart failure. Coronary flow reserve (CFR) was determined from PET. Echocardiograms were used to measure cardiac mechanics: diastolic (lateral and septal E/e') and systolic [global longitudinal (GLS), radial (GRS) and circumferential strain (GCS)]. Image analyses and event adjudication were blinded. The associations between estimated glomerular filtration rate (eGFR), CFR, diastolic, systolic indices and adverse CV outcomes were assessed in adjusted models and mediation analyses. Results: 352 patients (median age 65 years, 63% women and 22% black) were studied. 35% of patients had eGFR<60 ml/min/1.73 m2, median LVEF of 62% and median CFR of 1.8. eGFR and CFR were associated with diastolic and systolic indices, as well as future CV events (all p<0.05). In multivariable models, CFR but not eGFR was independently associated with cardiac mechanics and CV events. The associations between eGFR, cardiac mechanics and CV events were partly mediated via CFR. Conclusions: CMD but not eGFR was independently associated with abnormal cardiac mechanics and an increased risk of CV events. CMD may mediate the effect of CKD on abnormal cardiac function and CV events in those without overt CAD.
PMID: 31779467
ISSN: 1524-4539
CID: 4216192
Cardiovascular Issues Among Homeless People: An Issue that Needs Attention
Cardiovascular disease is one of the most common causes of death with social factors increasingly recognized as determinants of cardiovascular prognosis. Homelessness, transient or chronic, may be one of the factors which predict treatment access and eventual outcomes as socially and economically disadvantaged group has high prevalence of cardiovascular risk factors such as smoking, and delayed diagnosis and poor control of other risk factors such as diabetes and hypertension. This perspective article aims to discuss the issues associated with cardiovascular disease treatment, outcomes and future directions for homeless patients.
PMCID:7727041
PMID: 33343203
ISSN: 1179-5468
CID: 4724662
Canagliflozin and risk of skin and soft tissue infections in people with diabetes mellitus and kidney disease in the credence trial [Meeting Abstract]
Background: The skin's hypertonic microenvironment has a protective antimicrobial function that may be disrupted by sodium glucose cotransporter 2 inhibitors (SGLT2i). We aimed to describe skin and soft tissue infections (SSTI) in the CREDENCE trial and determine whether canagliflozin affects the risk of SSTIs.
Method(s): We performed a post-hoc analysis of the CREDENCE trial that randomised people with type 2 diabetes and albuminuric stage 2 and 3 chronic kidney disease to either canagliflozin 100mg daily or placebo. Adverse events were assessed by two blinded authors following predetermined criteria for SSTI with discrepancies resolved by consensus. We analysed the risks of SSTIs in the on-treatment population as the more conservative approach, with sensitivity analyses conducted in the intentionto- treat population, for serious events only and for participant subgroups. Univariable time-to first-event regression models were assessed.
Result(s): Overall 373/4397 (8.5%) participants experienced 478 events comprising 252 bacterial skin infections (including 2 episodes of necrotising fasciitis), 94 fungal skin infections, 109 other skin infections and 23 soft tissue infections. Of these, 136/478 (28%) were serious. Canagliflozin did not increase the risk of SSTI (HR 0.85 [95% Confidence Interval (CI) 0.69-1.04] p=0.11), with similar results in the intention-to-treat population (HR 0.88 [95% CI 0.73-1.07] p=0.20), in analyses confined to serious SSTI (HR 0.83 [95% CI 0.58-1.21] p=0.33) and participant subgroups (all p interaction>=0.10). Both cases of necrotising fasciitis were in patients assigned to canagliflozin and the participants recovered after drug was withdrawn.
Conclusion(s): Canagliflozin did not increase the risk of skin and soft tissue infections overall or in any subgroup, in CREDENCE trial participants with type 2 diabetes mellitus and albuminuric chronic kidney disease
Method(s): We performed a post-hoc analysis of the CREDENCE trial that randomised people with type 2 diabetes and albuminuric stage 2 and 3 chronic kidney disease to either canagliflozin 100mg daily or placebo. Adverse events were assessed by two blinded authors following predetermined criteria for SSTI with discrepancies resolved by consensus. We analysed the risks of SSTIs in the on-treatment population as the more conservative approach, with sensitivity analyses conducted in the intentionto- treat population, for serious events only and for participant subgroups. Univariable time-to first-event regression models were assessed.
Result(s): Overall 373/4397 (8.5%) participants experienced 478 events comprising 252 bacterial skin infections (including 2 episodes of necrotising fasciitis), 94 fungal skin infections, 109 other skin infections and 23 soft tissue infections. Of these, 136/478 (28%) were serious. Canagliflozin did not increase the risk of SSTI (HR 0.85 [95% Confidence Interval (CI) 0.69-1.04] p=0.11), with similar results in the intention-to-treat population (HR 0.88 [95% CI 0.73-1.07] p=0.20), in analyses confined to serious SSTI (HR 0.83 [95% CI 0.58-1.21] p=0.33) and participant subgroups (all p interaction>=0.10). Both cases of necrotising fasciitis were in patients assigned to canagliflozin and the participants recovered after drug was withdrawn.
Conclusion(s): Canagliflozin did not increase the risk of skin and soft tissue infections overall or in any subgroup, in CREDENCE trial participants with type 2 diabetes mellitus and albuminuric chronic kidney disease
EMBASE:633704209
ISSN: 1533-3450
CID: 4752662
Canagliflozin and risk of genital infections and urinary tract infections in people with diabetes mellitus and kidney disease in the credence trial [Meeting Abstract]
Background: Genital mycotic infections (GMI) and urinary tract infections (UTI) are common in patients with diabetes. We assessed the effects of canagliflozin on the risk of these infections in the CREDENCE trial population.
Method(s): The CREDENCE trial randomised people with type 2 diabetes and albuminuric stage 2 and 3 chronic kidney disease to canagliflozin 100mg daily or placebo. We analysed the risk of GMI and UTI with canagliflozin compared to placebo overall and in subgroups. The primary analysis was conducted in the on-treatment population. When canagliflozin increased risk, we determined patient risk factors for GMIs using multivariable Cox regression models.
Result(s): Overall 31/2905 (1.1%) men and 32/1492 (2.1%) women experienced 91 GMIs and 166/2905 (5.7%) men and 300/1492 (20.1%) women experienced 669 UTIs. 58/669 (8.7%) UTIs but no GMIs were reported as serious. Most participants continued treatment following their first infection with similar recurrence rates in the canagliflozin and placebo groups. Canagliflozin increased the risk of GMI (HR 3.83 [95% CI 2.08-7.06] p<0.0001). The hazard ratio (HR) for canagliflozin compared to placebo was consistent across most subgroups, though canagliflozin led to a greater increase in risk in those with a BMI>30 kg/ m2 compared to those with a BMI<30 kg/ m2 (HR 5.91 vs 1.36, p interaction=0.03) and in men compared to women (HR 9.30 vs HR 2.10, p interaction=0.04). In those who were randomised to canagliflozin, independent risk factors for GMI were higher BMI (HR 1.53 [95% CI 1.29-1.83] per 5 units p<0.0001) and longer diabetes duration (HR 1.18 [95% CI 1.01-1.40] per 5 years p=0.04). Canagliflozin did not affect the risk of UTI (HR 1.08 [95% CI 0.90-1.29] p=0.42) overall or in any subgroup.
Conclusion(s): Canagliflozin increased risk of GMI but not UTI. The proportional increase in GMI with canagliflozin was greater in men and people with higher BMI
Method(s): The CREDENCE trial randomised people with type 2 diabetes and albuminuric stage 2 and 3 chronic kidney disease to canagliflozin 100mg daily or placebo. We analysed the risk of GMI and UTI with canagliflozin compared to placebo overall and in subgroups. The primary analysis was conducted in the on-treatment population. When canagliflozin increased risk, we determined patient risk factors for GMIs using multivariable Cox regression models.
Result(s): Overall 31/2905 (1.1%) men and 32/1492 (2.1%) women experienced 91 GMIs and 166/2905 (5.7%) men and 300/1492 (20.1%) women experienced 669 UTIs. 58/669 (8.7%) UTIs but no GMIs were reported as serious. Most participants continued treatment following their first infection with similar recurrence rates in the canagliflozin and placebo groups. Canagliflozin increased the risk of GMI (HR 3.83 [95% CI 2.08-7.06] p<0.0001). The hazard ratio (HR) for canagliflozin compared to placebo was consistent across most subgroups, though canagliflozin led to a greater increase in risk in those with a BMI>30 kg/ m2 compared to those with a BMI<30 kg/ m2 (HR 5.91 vs 1.36, p interaction=0.03) and in men compared to women (HR 9.30 vs HR 2.10, p interaction=0.04). In those who were randomised to canagliflozin, independent risk factors for GMI were higher BMI (HR 1.53 [95% CI 1.29-1.83] per 5 units p<0.0001) and longer diabetes duration (HR 1.18 [95% CI 1.01-1.40] per 5 years p=0.04). Canagliflozin did not affect the risk of UTI (HR 1.08 [95% CI 0.90-1.29] p=0.42) overall or in any subgroup.
Conclusion(s): Canagliflozin increased risk of GMI but not UTI. The proportional increase in GMI with canagliflozin was greater in men and people with higher BMI
EMBASE:633704206
ISSN: 1533-3450
CID: 4752672
Lower transferrin saturation (TSAT) index is associated with an anemia-independent risk of increased mortality in non-dialysis (ND) CKD patients [Meeting Abstract]
Background: Iron Deficiency (ID), defined by a TSAT index <20 %, is present in approximately half of ND-CKD patients, varying little by CKD stage. Distinct from approaches in conditions such as heart failure, the importance of iron reserves and the basis for iron therapy in CKD has focused primarily on supporting effective erythropoiesis. A comprehensive approach and design to estimate the impact of ID, independently from hemoglobin (Hb) levels, on mortality risk has not been explored in ND-CKD until the present.
Method(s): 5144 patients from Brazil (N=294), France (N=2227), the US (N=494), and Germany (N=2129) enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013-2019 with available TSAT were included in the analysis. We categorized patients by first available TSAT at enrollment. Hb measurements at same time as TSAT were used. Cox models were used to estimate hazard ratios (HR) of TSAT on mortality, censored at start of dialysis or kidney transplantation. Models were progressively adjusted for confounders, including demographics, comorbidities, inflammation surrogates, treatment with erythropoietin stimulating-agents and Hb.
Result(s): Sample characteristics were: 59% male; 45% diabetes; and mean (SD) age 69 (13) years, eGFR 28 (11) mL/min, Hb 12 (2) g/dL, TSAT 24 (2) %, ferritin 196 (214) ng/dL. TSAT levels below 25% were progressively associated with higher mortality risk, while patients with TSAT greater than 45% tended to have higher risks for mortality (Figure).
Conclusion(s): ID, as measured by the TSAT index, is associated with higher risk of all-cause mortality in ND-CKD patients, even after extensive adjustments for clinical, demographic and biochemical confounders, including Hb levels. Interventional studies evaluating the impact of iron supplementation and alternative targets on clinical outcomes in ND-CKD patients are needed to better inform ID management strategies
Method(s): 5144 patients from Brazil (N=294), France (N=2227), the US (N=494), and Germany (N=2129) enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013-2019 with available TSAT were included in the analysis. We categorized patients by first available TSAT at enrollment. Hb measurements at same time as TSAT were used. Cox models were used to estimate hazard ratios (HR) of TSAT on mortality, censored at start of dialysis or kidney transplantation. Models were progressively adjusted for confounders, including demographics, comorbidities, inflammation surrogates, treatment with erythropoietin stimulating-agents and Hb.
Result(s): Sample characteristics were: 59% male; 45% diabetes; and mean (SD) age 69 (13) years, eGFR 28 (11) mL/min, Hb 12 (2) g/dL, TSAT 24 (2) %, ferritin 196 (214) ng/dL. TSAT levels below 25% were progressively associated with higher mortality risk, while patients with TSAT greater than 45% tended to have higher risks for mortality (Figure).
Conclusion(s): ID, as measured by the TSAT index, is associated with higher risk of all-cause mortality in ND-CKD patients, even after extensive adjustments for clinical, demographic and biochemical confounders, including Hb levels. Interventional studies evaluating the impact of iron supplementation and alternative targets on clinical outcomes in ND-CKD patients are needed to better inform ID management strategies
EMBASE:633699369
ISSN: 1533-3450
CID: 4752642
Early change in albuminuria with canagliflozin (CANA) predicts kidney and cardiovascular (CV) outcomes [Meeting Abstract]
Background: The association between early changes in albuminuria and kidney and CV events is primarily based on trials of renin-angiotensin system blockade. It is unclear whether this association is similar with sodium-glucose cotransporter 2 inhibitors.
Method(s): In this post-hoc analysis of the CREDENCE trial in patients with type 2 diabetes and chronic kidney disease, we assessed the effect of CANA versus placebo on albuminuria at week 26, and the association of early changes in urinary albumin:creatinine ratio (UACR) for the first 26 weeks with kidney and CV outcomes using multivariable Cox regression. Kidney and CV outcomes were defined as (1) endstage kidney disease, doubling of serum creatinine or death due to kidney disease, (2) major adverse cardiovascular events (MACE) and (3) hospitalization for heart failure (HHF) or CV death.
Result(s): This analysis included 3836 participants (87.2%) with complete data for early changes in UACR. CANA lowered UACR by 31% (95%CI 27-36%) at week 26 and increased the likelihood of achieving a 30% UACR reduction (OR 2.69, 95%CI 2.35- 3.07). We observed log-linear associations of early changes in UACR during 26 weeks with kidney and CV outcomes (all p trend <0.001; Table). Each 30% UACR reduction was independently associated with a lower hazard for clinical outcomes, overall and in each treatment arm (all p <0.001).
Conclusion(s): In people with type 2 diabetes and CKD, canagliflozin results in early and sustained reductions in albuminuria, which was independently associated with longterm kidney and cardiovascular outcomes. (Table Presented)
Method(s): In this post-hoc analysis of the CREDENCE trial in patients with type 2 diabetes and chronic kidney disease, we assessed the effect of CANA versus placebo on albuminuria at week 26, and the association of early changes in urinary albumin:creatinine ratio (UACR) for the first 26 weeks with kidney and CV outcomes using multivariable Cox regression. Kidney and CV outcomes were defined as (1) endstage kidney disease, doubling of serum creatinine or death due to kidney disease, (2) major adverse cardiovascular events (MACE) and (3) hospitalization for heart failure (HHF) or CV death.
Result(s): This analysis included 3836 participants (87.2%) with complete data for early changes in UACR. CANA lowered UACR by 31% (95%CI 27-36%) at week 26 and increased the likelihood of achieving a 30% UACR reduction (OR 2.69, 95%CI 2.35- 3.07). We observed log-linear associations of early changes in UACR during 26 weeks with kidney and CV outcomes (all p trend <0.001; Table). Each 30% UACR reduction was independently associated with a lower hazard for clinical outcomes, overall and in each treatment arm (all p <0.001).
Conclusion(s): In people with type 2 diabetes and CKD, canagliflozin results in early and sustained reductions in albuminuria, which was independently associated with longterm kidney and cardiovascular outcomes. (Table Presented)
EMBASE:633704233
ISSN: 1533-3450
CID: 4750032
