Canagliflozin in Advanced Renal Disease With MRI Endpoints

Inclusion Criteria: * advanced CKD, defined as an estimated glomerular filtration rate (eGFR) \< 20 ml/min/1.73m2 not yet on dialysis OR incident hemodialysis or peritoneal dialysis patients (i.e., who were started on dialysis in the last 6 months)\* \* For patients who were not previously followed in a CKD clinic and for whom it is not clear whether dialysis was initiated after an acute deterioration in renal function that is potentially reversible, at least 90 days of dialysis will be required prior to enrolment. This criterion only applies to patients for whom baseline eGFR prior to the acute event was ≥ 20 ml/min/1.73m2 or was unknown. The average creatinine values over the last 12 months will be used to calculate baseline eGFR. * LV hypertrophy, defined as LV mass \> 130 g/m2 in men and 100 g/m2 in females OR hospitalization for heart failure or atherosclerotic cardiovascular (CV) disease in the last 12 months OR type 2 diabetes OR UACR \> 200 mg/g on a morning spot urine collection (this criterion is not applicable to patients who are on dialysis and have a urine output \< 500 ml per day). Exclusion Criteria: * type 1 diabetes, * history of euglycemic ketoacidosis, * known hypersensitivity to sodium-glucose cotransporter-2 (SGLT-2) inhibitors, * hemodynamic instability (defined as current use of parenteral inotropic agents), * systolic BP \< 90 mmHg, * severe liver cirrhosis (Child-Pugh class C stage), * acute hepatitis (defined as an alanine aminotransferase \> 2…