Drug Lowers Risk Of Kidney Disease
The study included 4,401 people, at least 30 years of age, with type 2 diabetes and chronic kidney disease. Researchers randomly assigned people to take either canagliflozin or an inactive placebo.
People were treated on average for 2 1/2 years. The study was stopped early when results showed that the drug was helping.
Compared to people taking the placebo, those on the drug had a 34 percent lower risk of end-stage kidney disease, worsening kidney function, or death due to kidney problems.
End-stage kidney disease included a need for dialysis or transplantation, or signs of kidney failure.
People taking the drug also had a lower risk of cardiovascular death, heart attack, stroke, and hospitalization due to heart failure, compared to the placebo group.
The drug did have some safety concerns as well.
An earlier study of canagliflozin found an increased risk of leg, foot, or toe amputation in people taking the drug.
The new study found that this risk along with the chance of bone fractures was similar for the drug and placebo groups.
However, the risk of diabetic ketoacidosis was higher in people taking the drug compared to those taking the placebo. This life-threatening problem occurs in people with diabetes when the body breaks down fat too quickly, causing the blood to become acidic.
The results were published April 14 in The New England Journal of Medicine.
Newer Type 2 Diabetes Medications Have Heart And Kidney Disease Benefits Too
- Two newer classes of medications used to treat Type 2 diabetes have been shown to protect patients against heart disease and chronic kidney disease, in addition to their ability to help manage blood glucose.
- Patients with Type 2 diabetes have a high rate of chronic kidney and cardiovascular disease and more serious complications these newer glucose-lowering medicines could help to reduce those risks.
- A multi-disciplinary approach to Type 2 diabetes care that includes primary care, diabetes, kidney and heart specialists could increase integrated care and provide more patients with access to these treatments, if appropriate, and achieve better outcomes.
Embargoed until 4 a.m. CT / 5 a.m. ET Monday, Sept. 28, 2020
The statement reviews evidence from multiple, large, international, randomized controlled trials of two classes of blood sugar control medications sodium glucose co-transporter 2 inhibitors and glucagon like peptide-1 receptor agonists in patients with Type 2 diabetes, chronic kidney disease and those who were either at risk for or already had cardiovascular disease. The composite results of the trials found that SGLT2 inhibitors and GLP-1 RAs can safely and significantly reduce the risk of cardiovascular events and death, reduce hospitalization and slow the progression of chronic to end-stage kidney disease including the risks of dialysis, transplantation or death.
Analysis of the clinical trials results yielded these recommendations:
Are There Any New Treatments For Kidney Disease
The Food and Drug Administration has approved two medications that can help decrease the progression or worsening of chronic kidney disease.
Research has shown that dapagliflozin may reduce the progression of chronic kidney disease in people living with or without diabetes. Finerenone may also reduce the progression of chronic kidney disease in those living with diabetes, but the long-term side effects of this medication are currently unknown.
Three classes of medications have shown good outcomes in reducing kidney disease:
- angiotensin converting enzyme inhibitors, such as lisinopril
- angiotensin receptor blockers , such as losartan
- sodium-glucose co-transporter-2 inhibitors, including Farxiga and empagliflozin
ACE inhibitors and ARBs may reduce the progression of chronic kidney disease in people living with high blood pressure. These blood pressure medications help by reducing blood pressure and decreasing protein in the urine. SGLT2 inhibitors, which doctors use to treat diabetes, have shown improved long-term outcomes regarding kidney function.
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What Is Diabetic Kidney Disease
Diabetes is the leading cause of kidney disease. About 1 out of 3 adults with diabetes has kidney disease.1
When your kidneys are damaged, they cant filter blood like they should, which can cause wastes to build up in your body. Kidney damage can also cause other health problems.
Kidney damage caused by diabetes usually occurs slowly, over many years. You can take steps to protect your kidneys and to prevent or delay kidney damage.
Recommendations For Nephropathy Screening In Diabetes
Patients with diabetes should be screened on an annual basis for nephropathy. In individuals with type 1 diabetes, screening for nephropathy should start 5 years after diagnosis of diabetes since the onset of diabetes itself is usually known. It typically takes about 5 years for microvascular complications to develop. In patients with type 2 diabetes, screening should begin at initial diagnosis since the exact onset of diabetes is often unknown .
Diabetic nephropathy can be detected by the measurement of urine albumin or serum creatinine, and both tests should be performed at minimum annually those with abnormal levels should have repeat tests done sooner. The first stage of nephropathy is usually the onset of elevated urine albumin which predicts the development of CKD and a gradual decline in glomerular filtration rate . Some individuals with CKD, however, do not develop elevated urine albumin initially. It is therefore important that individuals have both blood and urine screening tests performed. Using both modalities allows for identification of more cases of nephropathy than using either test alone.
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Doctors Cautiously Optimistic Of Results
Over the past couple decades, diabetes treatment has shifted beyond just controlling blood glucose levels with insulin shots, diet, and exercise.
The prevention or delay of progression of complications and preservation of quality of life are goals of diabetes treatment, said Dr. Lorena Wright, an endocrinologist with UW Medicine in Seattle, who wasnt involved in the study. This requires glucose control but also renal and cardiovascular risk reduction.
Drugs like canagliflozin are part of this new approach to treatment. Its an SGLT2 inhibitor, which lowers blood glucose by increasing the amount of glucose that the kidneys get rid of in the urine.
Wright said this study confirms the growing evidence that SGLT2 inhibitors have protective effects on the kidneys.
Other doctors welcome medications to treat the complications of diabetes.
It is of tremendous value to have a drug option which may not only preserve, but also improve kidney function, said Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City, who wasnt involved in the new study.
Dr. Theodore Strange, associate chair of medicine at Staten Island University Hospital in Staten Island, New York, pointed out that canagliflozin could reduce the number of people with diabetes needing dialysis.
However, he said ongoing follow-up of this and similar drugs will be needed to ensure that their benefits are sustainable.
Drug Classes For Type 2 Diabetes
If you have diabetes, your doctor may prescribe pills to help control your blood sugar. There are six classes of diabetes pills. They work on your gut, your pancreas, your liver, your cells, or more than one of these:
- Sulfonyureas tell your pancreas to make more insulin.
- Meglitinides also tell your pancreas to make more insulinbut only when your blood sugar is high.
- Dipeptidyl peptidase IV inhibitors, like meglitinides, tell your pancreas to make more insulin when your blood sugar is high. They also tell your liver to stop making so much sugar.
- Thiazolidinediones make cells more sensitive to insulin so they take more sugar out of the blood, and help the liver to make less glucose.
- Biguanides help insulin move into your cells and keep your liver from releasing glucose it has stored.
- Alpha-glucosidase inhibitors block digestion of starch in your gut so blood sugar does not go up as fast.
Some diabetes drugs combine more than one of these classes into one pill.
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The Link Between Diabetes And Kidney Disease
People with diabetes are at high risk for kidney disease, but there are steps they can take to protect their kidneys.
Meda E. Pavkov, MD, PhD, medical epidemiologist in the Chronic Kidney Disease Initiative within the Division for Diabetes Translation at the Centers for Disease Control and Prevention , is a co-author of the Kidney Disease in Diabetes chapter in the NIDDK publication Diabetes in America, 3rd Edition. Here, she discusses the link between diabetes and kidney disease and the importance of early detection and management of kidney disease.
Q: What is the link between diabetes and kidney disease?
A: Diabetes is the most frequent cause of chronic kidney disease, not only in the United States but in most industrialized countries. Kidney disease in people with diabetes is caused by multiple factors, including diabetic changes in the kidneys as well as vascular changes due to hypertension. People with diabetes have high glycemia, or blood glucose, which can damage the kidneys and lead to kidney disease.
When people are diagnosed with diabetes, they may already have hypertension. Hypertension is an additional risk factor for diabetic kidney disease because high blood pressure damages the kidneys, which may prevent proper function.
Q: What are the benefits of talking about kidney disease risk factors with patients who have diabetes?
Q: Why is it so important to diagnose kidney disease in patients with diabetes as early as possible?
Medical Therapy In Diabetic Nephropathy
Medical therapy for diabetes is continually changing as new therapies become available for use and new updates are available that add to our knowledge of the safety profile of available medications. Please refer to Table for adjustments in dosing for diabetes medications used in CKD.
Table 1 Dose adjustment for insulin compounds and medications for diabetes in CKD
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Kidney Disease May Change Your Dose Of Diabetes Medicines
If you have diabetes, or high blood sugar, you may be taking medicines to help control your blood sugar. If your kidneys dont work well, some of these medicines could last longer than normal or build up to unsafe levels in your blood. So, your dose of diabetes medicines may need to change if you have kidney disease or if your kidneys fail. If you would like to learn more about diabetes and kidney disease, visit How to Slow Kidney Disease: When You Have Diabetes.
Great News: Trials Show Some Diabetes Drugs Can Actually Protect Your Kidneys
More people with diabetes are taking drugs like Jardiance and Farxiga, originally developed to lower glucose in people with type 2 diabetes, because the latest data confirms that these drugs can protect your kidneys. A therapy still under investigation, finerenone, has been developed to protect the kidneys of people with and without diabetes
Recent research is showing that certain drugs can benefit your kidneys if you have type 2 diabetes. Diabetes is the leading cause of chronic kidney disease , and many people dont receive adequate treatment for this condition, so advancements in therapy to treat and prevent kidney disease are important for the 800 million people worldwide who live with chronic kidney disease. We bring you some of the newest findings on finerenone, Jardiance, and Farxiga three medications that have been shown to protect the kidneys in people with decreased kidney function, including those with diabetes and CKD.
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Referral To A Nephrologist
Consider referral to a nephrologist when there is uncertainty about the etiology of kidney disease, for difficult management issues , or when there is advanced kidney disease requiring discussion of renal replacement therapy for ESRD . The threshold for referral may vary depending on the frequency with which a provider encounters patients with diabetes and kidney disease. Consultation with a nephrologist when stage 4 CKD develops has been found to reduce cost, improve quality of care, and delay dialysis . However, other specialists and providers should also educate their patients about the progressive nature of CKD, the kidney preservation benefits of proactive treatment of blood pressure and blood glucose, and the potential need for renal replacement therapy.
A complete list of members of the American Diabetes Association Professional Practice Committee can be found at .
Suggested citation: American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: Standards of Medical Care in Diabetes2022. Diabetes Care 2022 45:S175S184
People With Diabetes Face Large Out
Wright said unfortunately access to new medications for treating diabetes complications are for the most part restricted by cost.
Invokana costs about $500 to $600 a month in the United States, with no cheaper generic version available.
Out-of-pocket costs for patients will vary depending on their insurance. Some plans, though, may not even cover this drug.
Caremark, a pharmacy benefit manager for many insurance plans, recently removed Invokana from its drug formulary. That means people on these plans wanting to use this drug may end up paying the full price.
People with diabetes already have high medical expenses, spending about $16,750 per year on medical expenses, according to a recent study $9,600 of this is directly related to diabetes.
People without insurance are hardest hit by the cost of medications. But even patients with insurance may not be able to afford the copays for insulin and medications theyre taking for diabetes and its complications.
As a result, Patients may skip medications or simply may not be able to afford them, said Wright.
Sood said the hope is that more meaningful data, such as this new study, will improve insurance coverage for this and similar medications.
Better coverage of medications to treat the complications of diabetes could help make a dent in the cost of diabetes-related kidney disease. In 2011, this reached almost
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Whats Glucofort Diabetes Medication Kidney Disease
Glucofort is a dietary supplement specifically designed to help people who are worried about their rising blood sugar levels, as well as patients with serious health issues that require immediate interventions and treatments. Its packed with natural ingredients from different parts of the globe, and all incorporated to produce a product thats which is effective enough to boost the glucose metabolism in the body and fix up the levels returning to normal levels. This assists in preventing at an early stage, the varying signs of diabetes.
In addition, its organically-sourced vitamins, minerals, antioxidants, and other essential nutrients work in tandem to guard against the harmful fats that could affect the overall wellbeing of your body. If you think about this, Glucofort does more than simply eliminate warning signs that may cause diabetes. It assists in restoring energy levels, cleanses the bad stuff out of your body, and provides you with the motivation to shed some weight! The Glucofort formula is a sure bet your that youre enjoying a healthy lifestyle.
What Advice Would You Give People Who Are Managing Both Diabetes And Kidney Disease
One of the most common causes of chronic kidney disease is diabetes. Its important to manage your diabetes so it doesnt lead to severe damage to your kidneys.
Working with a healthcare professional to determine the right medication or medications to manage both diabetes and kidney disease, as well as making appropriate lifestyle changes, are effective ways of managing both diabetes and kidney disease.
Dr. Monica Kean is a clinical pharmacist with experience in hospital pharmacy and long-term care. She has experience helping patients in internal medicine, emergency medicine, and critical and hospice care. Dr. Kean currently practices as a clinical pharmacist at Texas Arlington Memorial Hospital.
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Control Your Blood Pressure
Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.
Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.
Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD. The names of these medicines end in pril or sartan. ACE inhibitors and ARBs are not safe for women who are pregnant.
What Is The Trial Testing
This study will enroll 807 participants with type 2 diabetes and chronic kidney disease to compare the safety and efficacy of combining finerenone and empagliflozin versus using each medicine separately.
Participants will be randomly assigned to receive either:
Finerenone and empagliflozin
Finerenone and placebo
Empagliflozin and placebo
The primary goal of the study is to see if the combination therapy of finerenone and empagliflozin has better results on the kidney than either drug individually. To evaluate this, the level of protein in your urine and kidney function will be measured.
Additionally, the study team will:
collect blood and urine samples
do a physical examination, including height and weight
check your heart health by using an electrocardiogram
monitor your blood pressure
ask questions about how you are feeling and any adverse events
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