Diabetes drugs postpone dialysis in the long term

Two diabetes medications delay the course of renal impairment up to a point, where patients only have to be dialyzed further in the future or not at all anymore. The medicines already exist and are prescribed to patients to lower the bloodsugar. UMCG professor of Clinical Pharmacology Hiddo Lambers Heerspink presents the promising results to fellow-scientists at a diabetescongress in Australia this week, and publishes about his research in two scientific journals: New England Journal of Medicine (NEJM) and The Lancet Diabetes & Endocrinology.

It’s the first time in 18 years that a diabetes medicine has been shown to reduce the risk of dialysis. According to Lambers Heerspink, there is an urgent need for new treatments, given the increasing number of people with diabetes. About 1.2 million people in the Netherlands have diabetes (1,200 new patients are added every month) and up to 40% will develop kidney disease

The study published in NEJM focuses on the drug canagliflozin. This medicine is now prescribed for people who can’t get their bloodsugar down with just diet and exercise. This study shows that the renal impairment of diabetic patients taking this medicine stabilizes almost completely. Because of this, patients only have to dialyze years later, or not at all. This greatly increases the quality of life because dialysis is a heavy burden for many patients and cannot be sustained indefinitely. The drug also reduces the risk of cardiovascular complications, including heart failure, which often occurs to people with kidney disease.

"Diabetes is the leading cause of kidney failure worldwide, but for almost two decades there has not been any new kind of treatment to protect the kidney function in patients with type 2 diabetes. This research result is a major medical breakthrough because people with diabetes and kidney disease have an extremely high risk to get kidney failure, a heart attack, a stroke or even death. We now have a very effective way of reducing this risk," says Lambers Heerspink.

The drug dapagliflozin (a sister-drug of canagliflozin, made by another manufacturer) has the same kind of effect. By combining this medicine with another diabetes medicine (saxagliptin), kidney impairment is delayed. It was found that with the combination of the two drugs there was a stronger effect on blood sugar and proteins in the urine, important risk factors for kidney failure. Although the patients in this study have been followed for shorter periods, the results give hope that this will also stabilize kidney impairment in the long term and that it will delay the moment the patient needs dialysis, with all the positive consequences this entails. Lambers Heerspink and his colleagues are publishing about this study in The Lancet.

The results of these studies can be applied immediately. These drugs are already available and can be prescribed by doctors. The guidelines that state which medicines doctors can prescribe in which situation are currently being adjusted based on these studies.