Analyzing heart and kidney outcomes after canagliflozin treatment in older adults

Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of cardiovascular and kidney outcomes in patients with type 2 diabetes, but it is unclear whether their effects differ based on patients’ age.

A recent analysis of clinical trial data reveals that the SGLT2 inhibitor canagliflozin benefited patients across all age categories. The findings were presented at ASN Kidney Week 2024 October 23–27.

The analysis pooled individual participant data from the CANVAS Program and CREDENCE trial and assessed efficacy and safety according to baseline age. Among the 14,543 participants, 7,927 (54.5%) were <65 years, 5,281 (36.3%) were 65 to <75 years, and 1,335 (9.2%) were ≥75 years.

Across age groups, canagliflozin reduced risks of major adverse cardiovascular events, hospitalization for heart failure or cardiovascular death, and chronic kidney disease progression.

Although the overall incidence of adverse events increased with age, the effects of canagliflozin on safety outcomes including acute kidney injury, volume depletion, urinary tract infections and hypoglycemia, were not modified by age.

“The prevalence of diabetes among older adults aged ≥65 years in the United States is estimated at 29.2%, a prevalence rate more than double that for the overall adult population aged ≥18 years, and older individuals with diabetes have higher absolute risks of cardiovascular events and kidney complications.

“Despite this, real-world uptake of SGLT2 inhibitors in older age groups is among the lowest of all patient groups,” said corresponding author Amanda Siriwardana, MBBS (Hon), GCert Public Health, FRACP, of The George Institute for Global Health in Australia.

“The data presented in this analysis suggests clear extension of the cardiorenal benefits of SGLT2 therapy to older individuals and should engender confidence among clinicians and patients regarding the safety of canagliflozin in older adults.”