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Canagliflozin reduces risk of hyperkalemia in diabetics with CKD:

Canagliflozin reduces risk of hyperkalemia in diabetics with CKD:

The use of canagliflozin reduces
the risk of hyperkalaemia in people with type-2 diabetes mellitus (T2DM) and chronic
kidney disease (CKD) without increasing the risk of hypokalaemia, suggests a
study published in the European Heart Journal

Hyperkalaemia is a
common complication of type 2 diabetes mellitus (T2DM) and limits the optimal
use of agents that block the renin-angiotensin–aldosterone system, particularly
in patients with chronic kidney disease (CKD). In patients with CKD,
sodium-glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal
protection, but whether they affect the risk of hyperkalaemia remains
uncertain.

Neuen B et. al. conducted
the CREDENCE trial wherein they randomized 4401 participants with T2DM and CKD
to the SGLT2 inhibitor canagliflozin or matching placebo. In this post hoc
analysis using an intention-to-treat approach, they assessed the effect of
canagliflozin on a composite outcome of time to either investigator-reported
hyperkalaemia or the initiation of potassium binders.

They also analysed
effects on central laboratory-determined hyper- and hypokalaemia and change in
serum potassium.

At baseline, the mean
serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%)
participants were receiving renin-angiotensin system blockade.

The
results of the study are as follows:

  • The
    incidence of investigator-reported hyperkalaemia or initiation of potassium
    binders were lower with canagliflozin than with placebo.
  • Canagliflozin
    similarly reduced the incidence of laboratory-determined hyperkalaemia, with no
    effect on the risk of hypokalaemia.
  • The mean
    serum potassium over time with canagliflozin was similar to that of placebo.

Thus the researchers
concluded that among patients treated with renin-angiotensin-aldosterone system
inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of
hyperkalaemia in people with T2DM and CKD without increasing the risk of
hypokalaemia.

Reference:

A study titled, “Effects of
canagliflozin on serum potassium in people with diabetes and chronic kidney
disease: the CREDENCE trial” by Neuen B et. al. published in the European Heart
Journal

https://doi.org/10.1093/eurheartj/ehab497

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