Evidence mapPaperPMID 35635326Full record

Trial reportDiabetes, obesity & metabolism2022

Mechanisms of action of the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin on tubular inflammation and damage: A post hoc mediation analysis of the CANVAS trial.

Taha Sen, Akihiko Koshino, Bruce Neal, Maarten J Bijlsma, Clare Arnott, Jingwei Li, Michael K Hansen, Joachim H Ix, Hiddo J L Heerspink

Open access · hybridAbstract readClinical Trial
In one paragraph

Trial report in Diabetes, obesity & metabolism, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
3.2field-weighted citation impact, top 7% 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.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · 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.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 27 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 4 countries.

Taha SenDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.ORCID 0000-0001-6359-2945
Akihiko KoshinoDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.ORCID 0000-0002-9432-2427
Bruce NealThe George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-0490-7465
Maarten J BijlsmaUnit PharmacoTherapy, Epidemiology, and Economics (PTEE), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.ORCID 0000-0002-7330-6006
Clare ArnottThe George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0001-9370-9913
Jingwei LiThe George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0003-1638-2317
Michael K HansenJanssen Research & Development, LLC, Spring House, Pennsylvania, USA.
Joachim H IxNephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA.ORCID 0000-0002-8084-9869
Hiddo J L HeerspinkDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.ORCID 0000-0002-3126-3730
UNSW Sydney · AUUniversity Medical Center Groningen · NLKanazawa University · JPSpringhouse · USUniversity of Groningen · NLUniversity of San Diego · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo test the hypothesis that the reduction in urinary kidney injury molecule-1 (KIM-1) observed with the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin is mediated through its effects on urine albumin to creatinine ratio (UACR) and monocyte chemoattractant protein-1 (MCP-1) by assessing the proportion of the effect of canagliflozin on KIM-1 that is mediated through its effects on MCP-1 and UACR in patients with type 2 diabetes and albuminuric kidney disease. MATERIAL AND

methodsWe measured KIM-1 and MCP-1 levels in urine samples from the CANVAS trial at baseline and Week 52 with the Mesoscale QuickPlex SQ 120 platform. KIM-1 and MCP-1 were standardized by urinary creatinine (Cr). The proportion of the effect of canagliflozin that is mediated through UACR and MCP-1/Cr on KIM-1/Cr was estimated with G-computation.

resultsIn total, 763 patients with micro- or macroalbuminuria (17.6% of the total cohort) were included. Baseline characteristics were well balanced between the canagliflozin and placebo group. At Year 1, canagliflozin compared to placebo reduced UACR, MCP-1/Cr and KIM-1/Cr by 40.4% (95% CI 31.0, 48.4), 18.1% (95% CI 8.9, 26.4) and 30.9% (95% CI 23.0, 38.0), respectively. The proportion of the effect of canagliflozin on KIM-1/Cr mediated by its effect on UACR and in turn on MCP-1/Cr was 15.2% (95% CI 9.4, 24.5).

conclusionCanagliflozin reduces urinary KIM-1, suggesting decreased tubular damage. This effect was partly mediated through a reduction in MCP-1, indicative of reduced tubular inflammation, which was in turn mediated by a reduction in UACR. This post hoc analysis suggests that urinary albumin leakage may lead to tubular inflammation and induction of injury, and provide mechanistic insight for how canagliflozin may ameliorate tubular damage, but further research is required to confirm these findings.

Indexed as

Diabetes Mellitus, Type 2Sodium-Glucose Transporter 2 InhibitorsAlbuminsCanagliflozinCreatinineGlucoseHumansInflammationMediation AnalysisSodiumSodium-Glucose Transporter 2AlbuminsCanagliflozinCreatinineGlucoseSodiumSodium-Glucose Transporter 2Sodium-Glucose Transporter 2 InhibitorsalbuminuriacanagliflozinCANVASKIM-1MCP-1type 2 diabetes

Identifiers

PMID35635326
PMCPMC9546391
OpenAlexW4281823790

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC
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.