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CREDENCE randomized patients with type 2 diabetes and albuminuric chronic kidney disease to canagliflozin or placebo on top of renin–angiotensin system blockade. Canagliflozin significantly reduced the risk of the composite of kidney failure, doubling of serum creatinine, or renal or cardiovascular death. The trial was important because it showed that SGLT2 inhibition can slow progression of diabetic kidney disease independently of its glucose-lowering effect. For internal-medicine practice, the study reinforced the need to identify CKD early and use albuminuria as more than a diagnostic marker—it is also a major risk-stratification tool. In eligible patients, nephroprotective therapy should be layered on to blood-pressure control, renin–angiotensin system blockade, glycemic management and cardiovascular risk reduction. Monitoring volume status, kidney function and adverse effects remains part of safe implementation. CREDENCE helped shift the treatment model from reactive management of advanced diabetic nephropathy to earlier disease modification intended to delay kidney failure and reduce cardiovascular burden.
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CREDENCE randomized patients with type 2 diabetes and albuminuric chronic kidney disease to canagliflozin or placebo on top of renin–angiotensin system blockade. Canagliflozin significantly reduced the risk of the composite of kidney failure, doubling of serum creatinine, or renal or cardiovascular death. The trial was important because it showed that SGLT2 inhibition can slow progression of diabetic kidney disease independently of its glucose-lowering effect. For internal-medicine practice, the study reinforced the need to identify CKD early and use albuminuria as more than a diagnostic marker—it is also a major risk-stratification tool. In eligible patients, nephroprotective therapy should be layered on to blood-pressure control, renin–angiotensin system blockade, glycemic management and cardiovascular risk reduction. Monitoring volume status, kidney function and adverse effects remains part of safe implementation. CREDENCE helped shift the treatment model from reactive management of advanced diabetic nephropathy to earlier disease modification intended to delay kidney failure and reduce cardiovascular burden.
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