A new treatment for people with type 2 diabetes and kidney disease reduced kidney failure rates by a third, according to a landmark trial. The results, published in The New England Journal of Medicine, also showed heart failure was reduced by over 30 per cent, and major cardiovascular events (including dying from heart and circulatory disease, or having a heart attack or stroke) by about 20 per cent.

The drug canagliflozin was developed to lower glucose levels for people with type 2 diabetes, but today has been shown to protect against kidney failure as well. It also significantly reduced the risk of cardiovascular complications including heart failure, which are common among people with kidney disease.

There are 4.7 million people in the UK living with diabetes and four in five people with diabetes will develop some form of kidney disease. Lead author Professor Vlado Perkovic, of The George Institute for Global Health, said there was an urgent need for this new treatment given the surging rates of diabetes.

Researchers say the results, which were presented at the ISN World Congress of Nephrology in Melbourne today, can be implemented immediately as the drug is already available.

The study recruited 4,401 patients with diabetes and kidney disease from 34 countries. Half were given canagliflozin on top of best available current care for kidney disease according to current guidelines – using either angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The control group received best available care, and a placebo.

Key findings

• The number of people developing kidney failure or dying from either kidney failure or cardiovascular disease was reduced by 30 per cent.
• Incidents of hospitalisation for heart failure were reduced by 39 per cent.
• The risk of major cardiovascular outcomes - heart attack, stroke and cardiovascular death - was reduced by 20 per cent.
• There was no increased risk of major side effects.

Canagliflozin is given to a small number of people with type 2 diabetes already, but it is hoped that more people will soon have access to the treatment as a result of this trial.

Big advance for patients

Director of research operations for Kidney Research UK Elaine Davies said: “At least four in five patients with diabetes will go on to develop kidney failure, and patients with type 2 diabetes also have a high risk of cardiovascular disease. Many treatments currently used to control blood glucose do nothing to reduce these risks, and some may even increase them.

“This new evidence is exciting and confirms previous research and provides hope for thousands of people. This new class of drugs help to control blood glucose but at the same time, reduce the risk of kidney and cardiovascular disease.

“This is the first big advance in preventing kidney failure in people with type 2 diabetes for generations. It complements evidence from recent trials which have shown the benefits of this class of drugs, and shows that the benefits extend to patients with early kidney disease. We’re hoping NICE and other bodies will look at the new evidence quickly, and review and implement guidelines with haste, so as many people as possible can benefit from these findings.”