A new treatment for people with diabetes and kidney disease reduced kidney failure rates by a third, a trial has found.
The results, published in the New England Journal of Medicine, also showed heart failure was reduced by over 30 per cent and major cardiovascular events by about 20 per cent.
The drug canagliflozin was developed to lower glucose levels for people with diabetes but today has been shown to protect against kidney failure.
It also significantly reduced the risk of cardiovascular complications including heart failure, which are common among people with kidney disease.
About 1.7 million people in Australia have diabetes and up to 40 per cent will go on to develop kidney disease.
Lead author Vlado Perkovic, of The George Institute for Global Health, said there was an urgent need for this new treatment given the surging rates of diabetes.
"Diabetes is the leading cause of kidney failure worldwide but for almost two decades there have been no new treatments to protect kidney function," Professor Vlado said.
"This definitive trial result is a major medical breakthrough as people with diabetes and kidney disease are at extremely high risk of kidney failure, heart attack, stroke and death.
"We now have a very effective way to reduce this risk using a once-daily pill."
Researchers say the results, which were presented at the ISN World Congress of Nephrology in Melbourne on April 15, can be implemented immediately as the class of drug is already available.
The study recruited 4401 patients with diabetes and kidney disease from 34 countries.
Half were given canagliflozin on top of best available current care for kidney disease - using either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
The control group received best available care according to current guidelines, and a placebo.
Key findings
The number of people developing kidney failure or dying from either kidney failure or cardiovascular disease was reduced by 30 per cent.
Incidents of hospitalisation for heart failure were reduced by 39 per cent..
The risk of major cardiovascular outcomes - heart attack, stroke and cardiovascular death - was reduced by 20 per cent.
There was no increased risk of major side effects.
Co-author Meg Jardine said trial found the drug not only protects people with diabetes from developing kidney failure, but it protects them from heart disease, heart failure and other cardiovascular complications.
"Importantly, it helps people who already have reduced kidney function and are at particularly high risk," Associate Professor Jardine said.
"With five million people worldwide predicted to have kidney failure by 2035 this is a major breakthrough."
Nino Bortolussi, a 62-year-old from Sydney who has lived with diabetes for three decades and now only has 20 [er cent kidney function, said he hoped the drug would be able to help many other patients with kidney disease.
"I have had two heart attacks in the last ten years and I am now unable to walk any real distance," the grandfather from Ermington said. "It would have been life-changing if I had had access to a drug that might have prevented not only my heart attacks, but my risk of developing kidney failure."
The researchers found canagliflozin, a sodium glucose transporter 2 (SGLT2) inhibitor, was less effective at lowering blood sugar in people with reduced kidney function but still led to less kidney failure, heart failure and cardiovascular events such as heart attacks, strokes and death from cardiovascular disease.
Professor Perkovic said the results were impressive. "The substantial benefit on kidney failure despite limited effects on blood glucose suggest that these drugs work in a number of different ways beyond their effects on blood sugar. This is an area of intense ongoing research."
