{"id":"a93caba9a36e","type":"article","url":"https://hartvaat.nl/2019/06/13/canagliflozine-en-renale-uitkomsten-bij-diabetes-type-2-met-nefropathie-nejm-cre/","title":"Canagliflozine en renale uitkomsten bij diabetes type 2 met nefropathie: NEJM CREDENCE","title_en":"Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine","chronische-nierziekte","credence-trial","diabetische-nefropathie","fidelio-dkd","flow-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1811744","source_url":"https://doi.org/10.1056/NEJMoa1811744","authors":["Vlado Perkovic","Meg J Jardine","Bruce Neal","Severine Bompoint","Hiddo J L Heerspink","David M Charytan","Robert Edwards","Rajiv Agarwal","George Bakris","Scott Bull","Christopher P Cannon","George Capuano","Pei-Ling Chu","Dick de Zeeuw","Tom Greene","Adeera Levin","Carol Pollock","David C Wheeler","Yshai Yavin","Hong Zhang","Bernard Zinman","Gary Meininger","Barry M Brenner","Kenneth W Mahaffey"],"significance":10,"published":"2019-06-13","source_date":"2019-06-13","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The CREDENCE trial demonstrated that canagliflozin significantly reduced the risk of kidney failure, cardiovascular events, and death in patients with type 2 diabetes and chronic kidney disease. As the first dedicated renal outcomes trial for an SGLT2 inhibitor, it established this drug class as a cornerstone of diabetic nephropathy treatment.","created":"2026-07-03T10:27:59Z","updated":"2026-07-03T13:27:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM CREDENCE-trial die aantoonde dat canagliflozine renale uitkomsten significant verbetert bij diabetische nefropathie. Eerste SGLT2-remmer specifiek voor nierziekte.","abstract_original":"BACKGROUND: Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium-glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS: In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin-angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS: The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P = 0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P = 0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P = 0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS: In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years. (Funded by Janssen Research and Development; CREDENCE ClinicalTrials.gov number, NCT02065791.)."}