The CREDENCE trial demonstrated that canagliflozin reduced renal outcomes in type 2 diabetics with CKD. The criteria for inclusion in this trial (defining the target patient population for SGLT2 inhibitor nephroprotection) included:
- A eGFR 30–90 mL/min AND urine ACR 300–5000 mg/g despite maximum tolerated RAS blockade ✓
- B eGFR > 60 mL/min only
- C Any type 2 diabetic with eGFR > 45 mL/min regardless of proteinuria
- D eGFR 45–75 mL/min with ACR > 100 mg/g
Correct answer: A. eGFR 30–90 mL/min AND urine ACR 300–5000 mg/g despite maximum tolerated RAS blockade
Explanation
The CREDENCE trial enrolled patients with type 2 diabetes, eGFR 30–90 mL/min/1.73m², and urine ACR 300–5000 mg/g (macroalbuminuria), who were already on maximum tolerated RAS blockade. Canagliflozin reduced the primary composite of ESRD, doubling of creatinine, renal death, or CV death by 30% versus placebo. This established SGLT2 inhibitors as renoprotective even at eGFR as low as 30 mL/min. Subsequently, DAPA-CKD extended these findings to CKD patients regardless of diabetic status.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.