Diabetes and Kidney Complications Garnering Attention at ISN

Maureen Salamon

March 26, 2019

MELBOURNE — First results from a phase 3 trial of canagliflozin (Invokana, Janssen) in patients with type 2 diabetes and chronic kidney disease top the list of anticipated highlights at the upcoming International Society of Nephrology (ISN): 2019 World Congress.

The CREDENCE trial (NCT02065791) was stopped nearly a year earlier than planned because it met the prespecified efficacy end points, as previously reported by Medscape Medical News.

David Harris

These findings could be "a big deal for patients with type 2 diabetes," said David Harris, MD, from the University of Sydney, who is president of the congress. "This trial is looking at its effect in patients who've already got diabetes and signs that diabetes has affected their kidneys, whereas previous studies focused on patients without kidney involvement," he explained.

About 4400 patients with type 2 diabetes were enrolled in the multicenter, randomized, double-blind, placebo-controlled study. All had albuminuria, and an estimated glomerular filtration rate that ranged from 30 to 89 mL/min per 1.73 m², and all had been taking an ACE inhibitor or an angiotensin-receptor blocker for at least 4 weeks before randomization.

Canagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, was approved for the treatment of type 2 diabetes in 2013 by the US Food and Drug Administration (FDA) and the European Medicines Agency. To lower the risk for heart attack, stroke, and death in these patients, the FDA expanded the indication in 2018 to include those with established cardiovascular disease.

"Diabetes is the most common cause of end-stage kidney disease around the world, and we may be able to use canagliflozin to prevent patients getting to the end stage and suffering complications of kidney disease, such as heart attack and stroke," Harris told Medscape Medical News.

The ISN has been concentrating its global outreach to improve standards of care for end-stage kidney disease, which is why it is one of the main focuses of the congress.

About two and a half million people go on dialysis every year for ESKD, but between that number and 7 million die because they don't have access to dialysis.

"About two and a half million people go on dialysis every year for ESKD, but between that number and 7 million die because they don't have access to dialysis," he said. "In a lot of developing countries, even if they have access to dialysis initially, the money runs out and patients die within a short period."

Peter Kerr

Despite how integral dialysis is to many patients, nephrologists don't discuss the procedure often enough, said Peter Kerr, PhD, from Monash Medical Center in Clayton, Australia, who is chair of the World Congress of Nephrology (WCN) local organizing committee.

"It's an underdone topic in conferences," Kerr told Medscape Medical News. "Nephrologists see it as something we have to do, as a necessary result of failed kidneys. The progression and cause of kidney disease is where the focus has been."

Masaomi Nangaku

An updated version of the 2017 Global Kidney Health Atlas, which will focus on Southeast Asia and be released at the congress, is something Masaomi Nangaku, MD, PhD, from the University of Tokyo Hospital, is looking forward to.

"It's a project to grasp the whole picture of kidney disease status and treatment and compare the differences among countries," said Nangaku, who is chair of the WCN scientific program committee.

"It's very important information," he told Medscape Medical News.

Findings from some major trials will also be presented at the congress, including first results from the SONAR trial (NCT01858532), which is assessing whether atrasentan can slow progression to end-stage renal disease in patients with type 2 diabetes and chronic kidney disease, and long-term follow-up data from the ACTIVE trial (NCT00649298), which is evaluating whether outcomes improve when dialysis is extended from 18 hours to 24 hours per week.

Harris has disclosed no relevant financial relationships. Kerr is a member of the advisory board for Bayer. Nangaku has financial relationships with KHK, Astellas, AstraZeneca, GSK, Daiichi-Sankyo, Tanabe-Mitsubishi, Chugai, Torii, JT, BI, Ono, Takeda, and Bayer.

Follow Medscape on Twitter @Medscape and Maureen Salamon @maureensalamon

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