Nephro Trial Files Throwback Thursday: Canagliflozin for Kidney Disease and T2DM, DASH Diet for BP, and Darbepoetin Alfa in CKD and T2DM
Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy
Perkovic V et al. NEJM (June 2019)
Bottom Line: This double-blind, randomized trial included 4401 patients with type 2 diabetes and albuminuric chronic kidney disease who were assigned to receive either canagliflozin or placebo for a median follow-up of 2.62 years. The primary outcome was a composite of end-stage kidney disease, a doubling of the serum creatinine level, or death from renal or cardiovascular causes. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group. The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke and hospitalization for heart failure. There were no significant differences in rates of amputation or fracture.
A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure
Appel LJ et al. NEJM (April 1997)
Bottom Line: This randomized controlled trial enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg. Subjects were randomly assigned to a control diet, a diet rich in fruits and vegetables, or a "combination" diet rich in fruits, vegetables, and low-fat dairy products and with reduced saturated and total fat for 8 weeks. The combination diet reduced systolic and diastolic blood pressure by 5.5 and 3.0 mm Hg more, respectively, than the control diet (P<0.001 for each); the fruits-and-vegetables diet reduced systolic blood pressure by 2.8 mm Hg more (P<0.001) and diastolic blood pressure by 1.1 mm Hg more than the control diet (P=0.07). The study concluded that a diet rich in fruits, vegetables, and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure.
A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease
Pfeffer MA et al. NEJM (November 2009)
Bottom Line: This randomized, double-blind, placebo-controlled trial included 4038 patients with diabetes, chronic kidney disease, and anemia. Patients were randomly assigned to receive darbepoetin alfa or placebo to achieve a hemoglobin level of approximately 13 g per deciliter with rescue darbepoetin alfa when the hemoglobin level was less than 9.0 g per deciliter. The primary end points were the composite outcomes of death or a cardiovascular event and of death or end-stage renal disease. The results showed that darbepoetin alfa did not reduce the risk of either of the two primary composite outcomes, and was associated with an increased risk of stroke. There was only a modest improvement in patient-reported fatigue in the darbepoetin alfa group.
Nephro Trial Files Issue #NPH-2023-04
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