Different eGFR decline thresholds and renal effects of canagliflozin: Data from the CANVAS program

Megumi Oshima, Bruce Neal, Tadashi Toyama, Toshiaki Ohkuma, Qiang Li, Dick de Zeeuw, Hiddo J.L. Heerspink, Kenneth W. Mahaffey, Gregory Fulcher, William Canovatchel, David R. Matthews, Vlado Perkovic

研究成果: ジャーナルへの寄稿学術誌査読

15 被引用数 (Scopus)

抄録

Background Traditionally, clinical trials evaluating effects of a new therapy with creatinine-based renal end points use doubling of serum creatinine (equivalent to a 57% eGFR reduction), requiring large sample sizes. Methods To assess whether eGFR declines,57% could detect canagliflozin's effects on renal outcomes, we conducted a post hoc study comparing effects of canagliflozin versus placebo on composite renal outcomes using sustained 57%, 50%, 40%, or 30% eGFR reductions in conjunction with ESKD and renal death. Because canagliflozin causes an acute reversible hemodynamic decline in eGFR, we made estimates using all eGFR values as well as estimates that excluded early measures of eGFR influenced by the acute hemodynamic effect. Results Among the 10,142 participants, 93 (0.9%), 161 (1.6%), 352 (3.5%), and 800 (7.9%) participants recorded renal outcomes on the basis of 57%, 50%, 40%, or 30% eGFR reduction, respectively, during a mean follow-up of 188 weeks. Compared with a 57% eGFR reduction (risk ratio [RR], 0.51; 95% confidence interval [95% CI], 0.34 to 0.77), the effect sizes were progressively attenuated when using 50% (RR, 0.61; 95% CI, 0.45 to 0.83), 40% (RR, 0.70; 95% CI, 0.57 to 0.86), or 30% (RR, 0.81; 95% CI, 0.71 to 0.93) eGFR reductions. In analyses that controlled for the acute hemodynamic fall in eGFR, effect sizes were comparable, regardless of whether a 57%, 50%, 40%, or 30% eGFR reduction was used. Estimated sample sizes for studies on the basis of lesser eGFR reductions were much reduced by controlling for this early hemodynamic effect. Conclusions Declines in eGFR,57% may provide robust estimates of canagliflozin's effects on renal outcomes if the analysis controls for the drug's acute hemodynamic effect.

本文言語英語
ページ(範囲)2446-2456
ページ数11
ジャーナルJournal of the American Society of Nephrology
31
10
DOI
出版ステータス出版済み - 10月 2020
外部発表はい

!!!All Science Journal Classification (ASJC) codes

  • 医学一般

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