Hi Scotty,
This is why all the excitement about SGLT2i including Canagliflozin.
This may be of interest to you to read. The DAPA-CKD study was done in patients with all cause CKD & is now approved for use to prevent renal decline, DKD & other. Full trial results & AJMC article below:
https://www.nejm.org/doi/full/10.1056/NEJMoa2024816https://www.ajmc.com/view/dapa-ckd-dapagliflozin-drops-risk-of-renal-decline-or-kidney-failure-death-39-even-withoutSomething that was of concern was events of hypoglycaemia for patients without diabetes, but there were zero events on the trial, which is good news & patients without diabetes were not seeing those adverse events associated with diabetes or any unexpected extra ones.
It also demonstrated some benefit in patients with an eGFR of <30mmol/L so stage 4 kidney disease, which has also been shown in a recent trial with Canagliflozin. It showed a reduction of kidney disease related death of 39% across the trial.
The other important factor to look at as well is the reduction in albuminuria (protein in the urine) which has been shown to be an important biomarker in the prediction of renal decline and heart disease. SGLT2i reduce UACR by 30% at least on top of current standard of care which is ARB (Angiotensin Receptor Blocking Agents) or ACEi (ACE 2 inhibitors).
Something to note though that all of this drug class causes an acute drop in eGFR when patients start on them, & then levels out over time with benefit & I think something that needs to be monitored especially with lower eGFR at baseline.
Anyway, I hope that helps, as now there are drugs available to slow progression of DKD/CKD & Drs should definitely be flagging eGFR below 60mmol/L because KDIGO guidelines now recommend starting an SGLT2i in diabetic patients with kidney disease & eGFR >30mmol/L. Which is where PromarkerD will be useful for predicting DKD & then monitoring when it does occur.
Just hurry up with the Janssen results lol!!
I have just finished listening to a presentation on SGLT2i from the major trials in cardio-renal disease including CREDENCE & cana at ADA & the DAPA-CKD trial above, one that may be of personal interest to you Scotty.
My Dad has CKD as well, but his is from permanent damage from an AKI (acute kidney injury) that saw him almost put on dialysis in ICU, but fortunately turned the corner. He’s a very lucky man! He has to be careful as well & regular monitoring. He can be non-compliant with Drs advice & meds etc (how CKD occurred in the first place) so all I can do is inform him about these things & maybe to talk to the GP about it.
Stay Well & thanks for sharing your story
(20min delay)