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Circulation. 2019 Jun 11. doi: 10.1161/CIRCULATIONAHA.119.041181. [Epub ahead of print]

More CREDENCE for SGLT2 Inhibition.

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Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA.


While rates of ischemic complications in type 2 diabetes mellitus seem to be declining, some of the most feared and costly complications, namely end-stage kidney disease (ESKD), heart failure, and lower limb amputations, remain on the rise. Herein, we discuss how the results from the Evaluation of the effects of canagliflozin on renal and cardiovascular outcomes in participants with diabetic nephropathy (CREDENCE) trial may change this calculus.1 The development of chronic kidney disease (CKD) in type 2 diabetes mellitus marks the beginning of a sharp increase in cardio-renal complications.2 Indeed, in type 2 diabetes mellitus, CKD is one of the strongest determinants of atherosclerotic vascular events and heart failure, with a hazard that parallels the degree/stage of kidney insufficiency. Thus, it is imperative that treatment goals of diabetic kidney disease (DKD) involve both kidney protection and cardiovascular risk reduction, particularly since many patients with DKD will have a cardiovascular event prior to developing ESKD.

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