ADVANCE demonstrated that intensive glucose control targeting HbA1c below 6.5% using a gliclazide-based strategy reduces nephropathy by 21% and the microvascular composite by 14% in high-risk type 2 diabetes, without the mortality hazard observed in ACCORD, providing important context for how glycaemic targets and treatment strategies interact with safety outcomes.
Browsing: Heart Failure & Renal Protection
DAPA-CKD demonstrated that dapagliflozin reduced the composite of a sustained 50% or greater eGFR decline, end-stage kidney disease, or renal or cardiovascular death by 39% in patients with albuminuric CKD with or without type 2 diabetes, extending nephroprotective SGLT2 inhibition beyond diabetic nephropathy to a broad CKD population for the first time.
EMPEROR-Reduced confirmed that empagliflozin reduces cardiovascular death or hospitalisation for heart failure by 25% in patients with HFrEF irrespective of diabetes status, while also demonstrating a 50% reduction in a renal composite outcome and a markedly slower rate of eGFR decline, adding critical confirmatory evidence for SGLT2 inhibitors as standard-of-care in HFrEF.
The DAPA-HF trial demonstrated that dapagliflozin reduced the composite of worsening heart failure or cardiovascular death by 26% in patients with heart failure and reduced ejection fraction, with consistent benefit observed in both those with and without type 2 diabetes, establishing SGLT2 inhibition as a core therapy for HFrEF independent of glycaemic status.
A biomarker substudy finds empagliflozin modulates sirtuins and microRNAs after myocardial infarction, with a panel predicting recovery. PICO summary and expert commentary.
The CREDENCE trial demonstrated that canagliflozin reduced the composite of end-stage kidney disease, doubling of serum creatinine, or renal or cardiovascular death by 30% in patients with type 2 diabetes and albuminuric chronic kidney disease, becoming the first dedicated renal outcomes trial to demonstrate that an SGLT2 inhibitor could substantially slow the progression of diabetic nephropathy.
The DECLARE-TIMI 58 trial demonstrated that dapagliflozin did not reduce 3-point MACE compared with placebo but significantly reduced the composite of cardiovascular death or hospitalisation for heart failure, driven entirely by a 27% reduction in heart failure hospitalisation, in the largest and most broadly representative SGLT2 inhibitor cardiovascular outcomes trial conducted to date.
An RCT finds pentoxifylline reduces microalbuminuria, preserves eGFR, and improves left ventricular mass index over 12 months in advanced diabetic nephropathy, using surrogate endpoints. PICO summary and commentary.
The FIVE-STAR mechanistic trial finds finerenone does not change arterial stiffness but reduces albuminuria in diabetic kidney disease, pointing to an intraglomerular-pressure mechanism. PICO summary and commentary.
A small biomarker RCT finds empagliflozin reduces the renal tubular marker KIM-1 in diabetic heart failure with preserved ejection fraction, with no effect on other biomarkers. PICO summary and commentary.