Canagliflozin reduces anemia risk in patients with CKD and diabetes: Lancet
Australia: Patients with chronic kidney disease (CKD) and type 2 diabetes who received SGLT2 inhibitor canagliflozin had a lower risk of anemia, according to a recent study in the journal Lancet Diabetes & Endocrinology. Canagliflozin also reduced the need for erythropoiesis-stimulating agents.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors might enhance process of RBC production (erythropoiesis) and increase red blood cell mass. Megumi Oshima, The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia, and colleagues assessed the long-term effects of canagliflozin on anaemia-related outcomes.
For the purpose, the researchers conducted a post-hoc analysis of the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial. The study 4401 participants with type 2 diabetes and chronic kidney disease. 2202 of them received treatment with canagliflozin and 2199 received placebo at 690 sites in 34 countries. The effects of canagliflozin versus matched placebo on haemoglobin and haematocrit were assessed using linear mixed-effects models.
The primary outcome of this post-hoc analysis was a composite outcome of investigator-reported anaemia or treatment for anaemia, which was assessed using Kaplan-Meier analysis and Cox regression models.
At baseline, mean haemoglobin concentration was 132·0 g/L (SD 17·7), 1599 (36%) of 4401 participants had anaemia (defined as haemoglobin <130 g/L in men or <120 g/L in women), and 33 (<1%) of 4401 participants used erythropoiesis-stimulating agents.
Key findings of the study include:
- During a median follow-up period of 2·6 years, mean haemoglobin concentration was 7·1 g/L higher and haematocrit was 2·4% higher in the canagliflozin group than the placebo group.
- 573 of 4401 participants had either an investigator-reported anaemia event or initiation of treatment for anaemia: 358 (8%) of 4401 participants reported anaemia events, 343 (8%) initiated iron preparations, 141 (3%) initiated erythropoiesis-stimulating agents, and 114 (2%) received blood transfusion.
- The risk of the composite outcome of anaemia events or initiation of treatment for anaemia was lower in the canagliflozin group than the placebo group (hazard ratio 0·65).
- Compared with the placebo group, participants in the canagliflozin group also had lower risks of anaemia events alone (0·58), initiation of iron preparations (0·64), and need for erythropoiesis-stimulating agents (0·65).
"These data suggest that canagliflozin reduces the risk of anaemia-associated outcomes, including the need for erythropoiesis-stimulating agents, among patients with type 2 diabetes and chronic kidney disease," concluded the authors.
"Effects of canagliflozin on anaemia in patients with type 2 diabetes and chronic kidney disease: a post-hoc analysis from the CREDENCE trial," is published in the journal Lancet Diabetes & Endocrinology.