Finerenone may give patients with type 2 diabetes, CKD some cardiovascular benefits
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Key takeaways:
- Adverse outcomes to finerenone did not vary by chronic kidney disease stage.
- Finerenone may provide cardiovascular benefits to patients with stage 4 chronic kidney disease.
Among patients with type 2 diabetes and chronic kidney disease, finerenone treatment may provide cardiovascular benefits, according to data published in the Clinical Journal of the American Society of Nephrology.
Previously, the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) study showed finerenone significantly reduces the risk of kidney composite outcome in patients with mean eGFR of 44.3 mL/min/1.73 m2 and median urine albumin-to-creatinine ratio (UACR) of 852 mg/g. The Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) study showed finerenone can reduce cardiovascular composite outcome risk in patients with less advanced CKD.
Additionally, the Finerenone in Chronic Kidney Disease and Type 2 Diabetes (FIDELITY) study is a combined analysis of FIDELIO-DKD and FIGARO-DKD.
Pantelis Sarafidis, MD, from the department of nephrology at Hippokration Hospital of Aristotle University of Thessaloniki in Greece, and colleagues investigated a subgroup of FIDELITY, to determine the impact finerenone specifically has on patients with stage 4 CKD.
Researchers examined data of 13,023 participants in FIDELITY, 890 of which had type 2 diabetes and stage 4 CKD, who were randomly assigned to receive either oral finerenone or placebo. The median follow-up was 3 years.
Overall, the HR for risk of cardiovascular composite with finerenone vs. placebo was 0.78. Although researchers could not identify the HR for the kidney composite, albuminuria and eGFR rates showed consistent reductions with finerenone vs. placebo. Both arms showed similar adverse outcomes, with hyperkalemia being the most commonly reported (26% for finerenone and 13% for placebo). However, researchers noted the presence of hyperkalemia did not lead to a high rate of discontinuation.
Therefore, according to the researchers, patients with stage 4 CKD showed similar reactions and cardiovascular benefits to finerenone to patients with less advanced CKD.
“Further research is warranted as the effect of finerenone on the composite kidney outcome in participants with stage 4 CKD was inconsistent in early vs. late years of follow-up, with a notable loss of precision over time. However, finerenone consistently showed improvements in markers of kidney injury (as shown by a reduction in UACR) and function (better preservation of eGFR in the chronic phase) vs. placebo in participants with stage 4 CKD,” Sarafidis and colleagues wrote. “These findings suggest that finerenone could provide cardiovascular benefits in participants with stage 4 CKD and type 2 diabetes, while also reducing albuminuria and the rate of eGFR decline.”
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