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

Co-development as transnational governance: An analysis of the engagement of local authorities and migrant organizations in Madrid

Fauser M. Co-development as transnational governance: An analysis of the engagement of local authorities and migrant organizations in Madrid. Journal of Ethnic and Migration Studies. 2014;40(7):1060-1078.This article provides an analysis of the co-development engagement of local authorities and migrant organisations from the city of Madrid. 'Co-development' has become a key notion that relates to the transnational involvement of migrants in development (cooperation). It is argued that co-development serves as transnational governance in which local authorities and migrant organisations collaborate and where links are established between integration, development and migration control and management. In order to analyse and understand these forms of engagement, the article combines an approach to the rescaling of governance with a transnational perspective on cities and migrants

Mixed Methods and Multisited Migration Research: Innovations From a Transnational Perspective

Fauser M. Mixed Methods and Multisited Migration Research: Innovations From a Transnational Perspective. Journal of Mixed Methods Research. 2018;12(4):394-412.This article discusses the use of mixed methods design for transnational migration research. It draws on two currently expanding strategies that can form part of an integrated framework that reveals multiple complementary perspectives: (a) the incorporation of quantitative data and methods in what has been a largely qualitative field and (b) the use of multisited research that investigates individuals and families connected across borders. This framework can be supported by collaboration of researchers across methodologies and state borders, which is addressed as a third strategy. By drawing on one research project that investigates the role of transnationality in the reproduction of social inequalities, this article explores the benefits and challenges of this approach