Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Photochromic naphthopyran dyes incorporating a benzene, thiophene or furan spacer: effect on photochromic, optoelectronic and photovoltaic properties in dye-sensitized solar cells

International audienceWe recently demonstrated that diaryl-naphthopyran photochromic dyes are efficient for sensitization of TiO2 mesoporous electrodes, thus allowing the fabrication of photo-chromovoltaic cells that can self-adapt their absorption of light and their generation of electricity with the light intensity. Herein we report the synthesis, the characterisation of two novel photochromic dyes based on diaryl-naphthopyran core i.e NPI-ThPh and NPI-FuPh for use in Dye Sensitized Solar Cells (DSSCs). Compared to our reference dye NPI, the molecules only vary by the nature of the spacer, a thiophene or a furan, connecting the photochromic unit and the phenyl-cyano-acrylic acid moiety used as the anchoring function. We found that swapping a phenyl for a thiophene or a furan leads to an improvement of the absorption properties of the molecules both in solution and after grafting on TiO2 electrodes, however their photochromic process becomes not fully reversible. Despite better absorption in the visible range, the new dyes show poorer photochromic and photovoltaic properties in devices compared to NPI. Thanks to UV-Vis spectroscopy, DFT calculation, electrical characterization of the cells, and impedance spectroscopy, we unravel the factors limiting their performances. Our stud

Push-pull photochromic dyes for semi-transparent solar cells with light-adjustable optical properties and high color-rendering index

International audienceWe report the design, synthesis and characterization of push-pull photochromic naphthopyran dyes, incorporating different carbazole moieties as the electron-donor group for use in dye-sensitized solar cells. Compared to a reference dye incorporating a diphenylamine-type donor moiety, the introduction of functionalized carbazoles allows for a hypsochromic shift of the absorption of the coloured isomers of the dyes in the visible region and a better tuning of their spectra to the photopic response of the human eye. Under illumination, the molecules exhibit a broad absorption with a maximum comprised between 546 nm and 571 nm in solution and they reveal relatively fast discoloration kinetics. By using these dyes to fabricate photochromic solar cells whose optical and photovoltaic properties vary with the light exposure, we have achieved a PCE of up to 3% in opaque cells. Using these molecules in semi-transparent solar cells with different electrolytes, a PCE of 2.3% was achieved. We also produced a semi-transparent mini-module with an average visible transmittance varying between 66% and 50% and a colour rendering index around 95 in both the uncoloured and coloured states

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (<45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791