Neuen BL, Oshima M, Perkovic V, et al. - Canagliflozin use for sodium‒glucose cotransporter 2 (SGLT2) inhibition in people with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) resulted in decrease in the risk of hyperkalemia without increasing the risk of hypokalemia, among patients treated with renin–angiotensin–aldosterone system inhibitors.

• Hyperkalemia limits the optimal use of agents that block the renin–angiotensin–aldosterone system, especially in CKD cases.

• This is a post hoc analysis of the CREDENCE trial which randomized 4401 patients with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo.

• At baseline, the mean serum potassium in both groups was 4.5 mmol/L.

• 4395 (99.9%) patients were on renin–angiotensin system blockade.

• Canagliflozin resulted in lower incidence of investigator-reported hyperkalemia or initiation of potassium binders, than placebo.

• Incidence of laboratory-determined hyperkalemia was decreased by canagliflozin, with no effect on the risk of hypokalemia.

• Over time, similar mean serum potassium was seen with canagliflozin vs placebo.