Evidence map›SGLT2 inhibitors × kidney outcomes›PMID 33316282›Full record

Trial reportKidney international2021

Insights from CREDENCE trial indicate an acute drop in estimated glomerular filtration rate during treatment with canagliflozin with implications for clinical practice.

Megumi Oshima, Meg J Jardine, Rajiv Agarwal, George Bakris, Christopher P Cannon, David M Charytan, Dick de Zeeuw, Robert Edwards, Tom Greene, Adeera Levin and 10 more

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Kidney international, 2021. The graph read 1 number from its abstract, feeding 1 cell of the map: it supports the treatment in 1. Cited by 72 papers, 7 of them syntheses that pooled it.

1number the graph read from it
1cell of the map it votes in
72citing papers in PubMed, 7 pooled it
13.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the comparatorfavours the treatment →
21 · no effect
Drop in eGFR over 10%canagliflozin vs placebofavours the treatment · t2d, ckdfeeds one cell of the map
OR 3.032.65 to 3.47
The odds ratio for a drop in eGFR over 10% with canagliflozin compared to placebo was significant at 3.03 (95% confidence interval 2.65, 3.47).
FeedsSGLT2 inhibitors×kidney outcomes

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

SGLT2 inhibitors×kidney outcomes

SupportsOpen on the map →What to test next →

13 readable studies in this cell: 10 favour the treatment, 1 find no difference, 2 favour the comparator.

Belief with this paper
0.89established · 8 families support, 1 contradict · against placebo
Without it
0.88This paper moves it by +0.01.
← favours the comparatorfavours the treatment →
1 · no effect
This paper · 2021
OR 3.032.65 to 3.47
NCT02864914333,580 enrolled · 2016
IRR 0.690.45 to 1.05
NCT0546531762,197 enrolled · 2022
HR 0.750.65 to 0.86
NCT0173053417,190 enrolled · 2013
HR 0.760.67 to 0.87
NCT030579515,988 enrolled · 2017
Treatment by time interaction 1.360.86 to 1.86
NCT019897545,813 enrolled · 2014
HR 0.640.57 to 0.73
NCT020657914,401 enrolled · 2014
HR 0.700.59 to 0.82
NCT010326294,330 enrolled · 2009
OR 0.800.67 to 0.97
NCT030579773,730 enrolled · 2017
Treatment by time interaction 1.730.67 to 2.80
Early Change in Albuminuria with Canagliflozin Predicts Kidney and Car…PMID 32998938 · 2020
OR 2.692.35 to 3.07
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

72 citing papers in PubMed, 7 syntheses or guidelines pooled it, 150 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Review
  19. Review
  20. Article

12 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

20 authors at 17 institutions in 8 countries.

Megumi OshimaDepartment of Renal and Metabolic, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia; Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.
Meg J JardineDepartment of Renal and Metabolic, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia; Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Rajiv AgarwalIndiana University School of Medicine and Veterans Affairs Medical Center, Indianapolis, Indiana, USA.
George BakrisDepartment of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
Christopher P CannonCardiovascular Division, Baim Institute for Clinical Research, Boston, Massachusetts, USA.
David M CharytanNephrology Division, NYU School of Medicine and NYU Langone Medical Center, New York, New York, USA; and Baim Institute for Clinical Research, Boston, Massachusetts, USA.
Dick de ZeeuwDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Robert EdwardsJanssen Research & Development, LLC, Raritan, New Jersey, USA.
Tom GreeneDivision of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.
Adeera LevinDivision of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
Soo Kun LimDivision of Nephrology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Kenneth W MahaffeyDepartment of Medicine, Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California, USA.
Bruce NealDepartment of Renal and Metabolic, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
Carol PollockKolling Institute of Medical Research, Sydney Medical School, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Norman RosenthalJanssen Research & Development, LLC, Raritan, New Jersey, USA.
David C WheelerDepartment of Renal Medicine, UCL Medical School, London, UK.
Hong ZhangRenal Division, Peking University First Hospital, Beijing, China.
Bernard ZinmanLunenfeld-Tanenbaum Research Institute, Mt Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Vlado PerkovicDepartment of Renal and Metabolic, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
Hiddo J L HeerspinkDepartment of Renal and Metabolic, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: h.j.lambers.heerspink@umcg.nl.
Janssen (United States) · USUniversity Medical Center Groningen · NLUNSW Sydney · AUBaim Institute for Clinical Research · USConcord Repatriation General Hospital · AUIndiana University School of MedicineKanazawa University · JPNYU Langone Health · USPeking University · CNStanford Medicine · USThe University of Sydney · AUUniversity College London · GBUniversity of British Columbia · CAUniversity of Chicago · USUniversity of Malaya · MYUniversity of Toronto · CAUniversity of Utah · US

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

Canagliflozin slows the progression of chronic kidney disease in patients with type 2 diabetes and induces a reversible acute drop in estimated glomerular filtration rate (eGFR), believed to be a hemodynamic effect. Predictors of the initial drop and its association with long-term eGFR trajectories and safety outcomes are unknown. To assess this, we performed a post-hoc analysis of 4289 participants in the CREDENCE trial with type 2 diabetes and chronic kidney disease equally split into treatment and placebo groups who had eGFR measured at both baseline and week three. The eGFR was categorized at week three as greater than a 10% decline; between 0 and 10% decline; and no decline. Long-term eGFR trajectories and safety outcomes were estimated in each category of acute eGFR change by linear mixed effects models and Cox regression after adjustment for baseline characteristics and medications use. Significantly more participants in the canagliflozin (45%) compared to the placebo (21%) group experienced an acute drop in eGFR over 10%. An over 30% drop occurred infrequently (4% of participants with canagliflozin and 2% with placebo). The odds ratio for a drop in eGFR over 10% with canagliflozin compared to placebo was significant at 3.03 (95% confidence interval 2.65, 3.47). Following the initial drop in eGFR, multivariable adjusted long-term eGFR trajectories, as well as overall and kidney safety profiles, in those treated with canagliflozin were similar across eGFR decline categories. Thus, although acute drops in eGFR over 10% occurred in nearly half of all participants following initiation of canagliflozin, the clinical benefit of canagliflozin was observed regardless. Additionally, safety outcomes were similar among subgroups of acute eGFR drop.

Indexed as

Diabetes Mellitus, Type 2Renal Insufficiency, ChronicSodium-Glucose Transporter 2 InhibitorsCanagliflozinGlomerular Filtration RateHumansCanagliflozinSodium-Glucose Transporter 2 Inhibitorscanagliflozinchronic kidney diseaseSGLT2 inhibitortype 2 diabetes

Identifiers

PMID33316282
OpenAlexW3112498330

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.