From the Guidelines
Canagliflozin is recommended for diabetic patients with microalbuminuria as it provides renoprotective benefits beyond glycemic control, with a standard dosing of 100 mg once daily. The mechanism of canagliflozin involves inhibiting sodium-glucose cotransporter 2 in the proximal tubule, reducing glucose reabsorption and increasing urinary glucose excretion, which decreases glomerular hyperfiltration by activating tubuloglomerular feedback, reducing intraglomerular pressure and albuminuria 1.
Key Considerations
- For patients with reduced kidney function, 100 mg daily is appropriate if eGFR is 30-60 mL/min/1.73m², but it should not be initiated if eGFR is below 30, as supported by the 2022 guideline which recommends use of SGLT2 inhibitors like canagliflozin for patients with eGFR ≥20 mL/min/1.73 m² and urine albumin ranging from normal to 200 mg/g creatinine 1.
- Clinical trials, including the CREDENCE trial, have shown that canagliflozin significantly reduces the risk of kidney disease progression, decreases albuminuria, and slows eGFR decline in diabetic patients 1.
- Patients should be monitored for side effects including genital mycotic infections, urinary tract infections, and volume depletion.
- Blood pressure, kidney function, and albuminuria levels should be regularly assessed, with a goal of blood pressure levels < 140/90 mmHg to reduce CVD mortality and slow CKD progression among people with diabetes 1.
- Canagliflozin should be used as part of a comprehensive treatment approach that includes optimal blood pressure control and use of ACE inhibitors or ARBs, which are the preferred first-line agents for blood pressure treatment among patients with diabetes, hypertension, eGFR < 60 mL/min/1.73 m², and UACR ≥ 300 mg/g Cr 1.
Monitoring and Comprehensive Care
- Regular monitoring of side effects and kidney function is crucial.
- Comprehensive treatment should include lifestyle modifications and other pharmacological interventions as needed.
- The use of canagliflozin in patients with type 2 diabetes and diabetic kidney disease is recommended to reduce CKD progression and cardiovascular events, with consideration of individual patient factors and comorbidities 1.
From the Research
Role of Canagliflozin in Treating Diabetic Patients with Microalbuminuria
- Canagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been shown to reduce albuminuria and slow the decline of estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes and microalbuminuria 2.
- The CANPIONE study demonstrated that canagliflozin reduced albuminuria by 30.8% and slowed the decline of eGFR by 4.4 ml/min/1.73 m2 per year compared to the control group 2.
- Other studies have also shown that canagliflozin improves glycemic control, reduces body weight and blood pressure, and is generally well tolerated in patients with type 2 diabetes and chronic kidney disease (CKD) 3, 4.
Efficacy and Safety of Canagliflozin in Patients with CKD
- Canagliflozin has been shown to be effective in reducing HbA1c, body weight, and blood pressure in patients with type 2 diabetes and stage 3 CKD 3, 4.
- The CREDENCE trial demonstrated that canagliflozin reduced the risk of kidney failure and cardiovascular events in patients with type 2 diabetes and CKD, including those with eGFR <30 ml/min/1.73 m2 5.
- A Japanese study also showed that canagliflozin safely reduces the risk of end-stage renal disease in patients with type 2 diabetes and CKD 6.
Key Findings
- Canagliflozin reduces albuminuria and slows the decline of eGFR in patients with type 2 diabetes and microalbuminuria.
- Canagliflozin improves glycemic control, reduces body weight and blood pressure, and is generally well tolerated in patients with type 2 diabetes and CKD.
- Canagliflozin is effective in reducing the risk of kidney failure and cardiovascular events in patients with type 2 diabetes and CKD, including those with eGFR <30 ml/min/1.73 m2.