Annals of the Academy of Medicine Singapore· 2026Q2
A randomised controlled study of canagliflozin in improving diabetic kidney disease through a podocyte protection mechanism
- 1citations
- Q2SCImago
- 2026year
Short summary
Canagliflozin (100 mg/day) significantly reduced kidney damage markers in DKD patients over 12 weeks, including BUN (-0.67 mmol/L), 24h-UP (0.73 ratio), UACR (0.72 ratio), urinary podocyte count (0.48 ratio), and urinary podocalyxin/creatinine (0.72 ratio), compared to placebo, even with similar blood glucose control.
AI-generated from the title and abstract; the full text is not read.
Key points
- Canagliflozin (100 mg/day) reduced BUN by -0.67 mmol/L, 24h-UP by 27%, UACR by 28%, urinary podocyte count by 52%, and urinary podocalyxin/creatinine by 28% vs. placebo over 12 weeks.
- These improvements in kidney damage markers occurred despite comparable blood glucose control between the canagliflozin and placebo groups.
- Canagliflozin significantly reduced urinary podocyte count and urinary podocalyxin/creatinine ratio, indicating direct protection of podocytes.
- Mediation analysis suggests that podocyte protection (UPCX/Ucr reduction) is a key mechanism driving the reduction in urinary protein (UACR and 24h-UP) by canagliflozin.
AI-generated from the title and abstract; the full text is not read.
Abstract
Introduction: This study aimed to investigate whether canagliflozin improves diabetic kidney disease (DKD) through a podocyte protective mechanism. Method: DKD patients were randomly assigned to the experimental group (87 patients: standard therapy plus cangliflozin 100 mg/day) and the control group (85 patients: standard therapy plus placebo tablets), with a treatment course of 12 weeks. Investigators and outcome assessors were blinded to allocation. Changes in blood glucose, DKD-related indicators (serum albumin, serum creatinine, blood urea nitrogen [BUN], 24-hour urinary protein [24h-UP], urinary albumin-to-creatinine ratio (UACR), and podocyte injury markers (urinary podocyte count, urinary podocalyxin-to-urinary creatinine ratio [UPCX/Ucr]) were compared. Linear mixed-effects models were used to compare intergroup differences, and mediation effect analysis was performed to evaluate the role of UPCX/Ucr in the improvement of DKD-related indicators by canagliflozin. Results: Under comparable blood glucose control, the experimental group showed superior outcomes in reducing BUN (between‑group difference at week 12: -0.67 mmol/L, 95% confidence interval [CI] -1.10 to -0.24), 24h-UP (geometric mean ratio 0.73, 95% CI 0.65 to 0.82), UACR (geometric mean ratio 0.72, 95% CI 0.65 to 0.80), urinary podocyte count (geometric mean ratio 0.48, 95% CI 0.43 to 0.54), and UPCX/Ucr (geometric mean ratio 0.72, 95% CI 0.66 to 0.79) compared to the control group. Mediation analysis revealed that UPCX/ Ucr exerted a significant indirect effect in the reduction of UACR (indirect effect = -0.968, 95% CI -1.171 to -0.774) and 24h‑UP (indirect effect = -0.783, 95% CI -1.127 to -0.655) by canagliflozin, with no statistically significant direct effects. For serum creatinine reduction, UPCX/Ucr played a partial mediating role with a small indirect effect (indirect effect = -0.301, 95% CI -0.437 to -0.153), alongside a significant direct effect. Conclusion: Canagliflozin provides significant renal protective effects for DKD patients, effectively lowering blood glucose while reducing urinary protein, lowering serum creatinine from baseline, and protecting podocytes. The reduction in urinary protein appears to be statistically mediated by podocyte protection, rather than being solely dependent on blood glucose control. However, this mediation analysis does not establish causality.
The authors' abstract, as published at the source. Annals of the Academy of Medicine Singapore, 2026 · DOI ↗
The rest is in the Pofolia app
Takeaways and questions to the paper; new summaries every day for your field. Free.
Sign in on the web to openField: Endocrinology, Diabetes and Metabolism
Endocrinology, Diabetes and MetabolismMedicine