Diabetic kidney disease is the number one cause of end stage kidney disease in the United States.  It typically presents with protein in the urine.  Initially, the kidneys’ ability to filter is good, but with time, will deteriorate.  Ultimately, the kidneys fail, and many patients end up needing dialysis. 

Use of ACE inhibitors (lisinopril, benazapril, etc.) and ARBs (losartan, valsartan, etc.) have been the main tool to slow the progression of diabetic kidney disease.  These are blood pressure medications that also reduce the protein in the urine and slow the damage in the kidneys. 

Recent studies have shown a role for SGLT2 inhibitors. These are medications originally approved for diabetes – canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin.  The CREDENCE trial was recently published.  This looked at the use of canagliflozin for diabetic kidney disease.  This showed a 34% reduction in the risk of “renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes.”    

This fall, the FDA added this indication to the canagliflozin label, and can be initiated in patients throughout stage CKD stage 3.  Additionally, patients can remain on this medication when they progress to CKD stage 4 – although it does need to be stopped if a patient is on dialysis. 

This is an exciting new option for treating diabetic kidney disease.  Like all medications, there are potential side effect.  In the next post, we will discuss some of the other benefits and potential side effects of this treatment option.