Efficacy and Safety of Canagliflozin in Patients with Persistent Drop in eGFR Below 30 mL/min per 1.73 m2: Insights from the CREDENCE Clinical Trial
Bibliographic record
Abstract
Background: The CREDENCE clinical trial randomized patients with type 2 diabetes and chronic kidney disease (CKD) to receive canagliflozin 100 mg daily or matching placebo. Patients with progressive decline in renal function were allowed to stay on the study medication until dialysis initiation. Clinical outcomes in patients with a persistent drop in eGFR below 30 ml/min/1.73m2 have not yet been reported. Methods: This is a post-hoc analysis from the CREDENCE clinical trial. Patients with persistent drop in eGFR below 30 ml/min/1.73m2 were followed from the time point they progressed to stage IV CKD until the end of the study (N=597). The primary outcome was CKD progression, defined as doubling of serum creatinine, progression to kidney failure, or renal death. Secondary outcomes included cardiovascular endpoints, all-cause mortality, and safety outcomes. Inverse probability weighted Cox proportional hazard regression was used. Results: Baseline characteristics were similar in both study arms. The incidence of CKD progression was lower with canagliflozin, compared with placebo: 17.2 vs. 25.2 events per 100 patient-years, hazard ratio (HR) 0.70 (95% confidence interval (CI) 0.50-0.99, p=0.04) (Figure). There was no difference in the incidence of cardiovascular outcomes and all-cause mortality between the study groups. The incidence of acute kidney injury and hyperkalemia was low in both study arms with no significant difference between patients treated with canagliflozin or placebo (Figure). Conclusion: The benefit from canagliflozin on CKD progression was sustained in patients with persistent GFR decline below 30 ml/min/1.73m2. No safety signal was detected in this population. Funding: Private Foundation Support, Government Support – Non-U.S.Figure. Clinical outcomes in patients with persistent GFR decline <30 ml/min/1.73m2.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".