Kidney Matters - Issue 6, Summer 2019

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C O N T I N U E D
healthy people lose about 1 ml/min or 1% of kidney
function each year. So the people in the trial were
losing their kidney function at a very high rate, and we
were able to dramatically reduce this loss, not quite
back to normal, but certainly very significantly.”
The benefits seen in the study do not appear to be linked
to lower blood glucose levels. In fact, the effects on
blood glucose were less than that seen in other studies.
“Because SGLT2 inhibitors act through the kidney,
their ability to reduce blood sugar levels falls as
kidney function declines. Despite this, we saw these
profoundly beneficial effects on the kidney. I now
describe SGLT2 inhibitors as kidney drugs, rather than
medicines to lower glucose,” says Vlado.
Is the treatment safe?
In CREDENCE, canagliflozin seemed to be safe with no
unexpected side effects. There is known to be a higher
risk of thrush with SGLT2 inhibitors, because they
increase the amount of glucose in the urine. This can
usually be treated easily with a topical cream and there
is no need to stop the medication.
The only other cause for concern in CREDENCE was
diabetic ketoacidosis, a serious condition that occurs
when the body produces high levels of blood acids,
called ketones. This is uncommon in people with type 2
diabetes, but is more frequent with SGLT2 inhibitors.
“Everyone with diabetes
should have their kidney
function tested each year”
Glucose
Figure 1: SGLT inhibitors and the kidney
Blood
Kidneys normally
reabsorb glucose
back into the body
Vlado adds: “In the trial, diabetic ketoacidosis occurred
in 11 people treated with canagliflozin compared to one
person receiving placebo. Everyone recovered, but it is
something we need to keep in mind. However, there were
none of the other adverse effects seen in other studies
that might have been associated with SGLT2 inhibitors,
such as fractures or amputations. This suggests that
treatment with canagliflozin was overall very safe.”
Reabsorption of
glucose is blocked
by SGLT inhibitor
The blood takes
glucose to the kidneys
Glucoses now passes
out of the body in the
urine, so lowering blood
glucose