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Dec 19, 2022
The following is a summary of “Finerenone and Heart Failure Outcomes by Kidney Function/Albuminuria in Chronic Kidney Disease and Diabetes” published in the November 2022 issue of Heart Failure by Filippatos et al.
Low kidney function (estimated glomerular filtration rate [eGFR]) and high albuminuria both increase the risk of cardiovascular mortality and heart failure (HF) in patients with type 2 diabetes (T2D) (urine albumin-to-creatinine ratio [UACR]). Patients with chronic kidney disease (CKD) with type 2 diabetes saw improved cardiorenal outcomes when treated with finerenone, a selective, nonsteroidal mineralocorticoid receptor antagonist, in the FIDELITY trial (Finerenone in Chronic Kidney Disease and Type 2 Diabetes: Combined FIDELIO-DKD and FIGARO-DKD Trial Programme Analysis). The purpose of this research was to assess finerenone’s impact on HF outcomes according to eGFR and/or UACR groups.
There were 13,026 participants in the FIDELITY study who had T2D and CKD (UACR 30-5,000 mg/g and eGFR 25 mL/min/1.73 m2). Subgroup analyses were performed by baseline eGFR (<60 and ≥60 mL/min/1.73 m2) and/or UACR (<300 and≥300 mg/g) to determine the time to event outcomes of the first hospitalization for heart failure (HHF), cardiovascular death or first HHF, recurrent HHF, and cardiovascular death or recurrent HHF. Risks of first HHF (HR: 0.78 [95% CI: 0.66-0.92]; P= 0.003), cardiovascular death, or first HHF (HR: 0.83 [95% CI: 0.74-0.93]; P=0.002), recurrent HHF (HR: 0.79 [95% CI: 0.64-0.96]; P=0.021), and cardiovascular death or recurrent HHF (HR: 0.82 [95% CI: 0.72-0]). 
Outcomes risk rose with decreasing eGFR and UACR at baseline, with the lowest incidences among those with eGFR ≥60 mL/min/1.73 m2 and UACR <300 mg/g. All categories of baseline eGFR and/or UACR were associated with improved HF outcomes after treatment with finerenone (all P interaction values >0.10). Finerenone improved HF-related outcomes in patients with CKD and T2D compared to placebo, and these advantages were observed regardless of the patient’s eGFR or UACR. (Figaro-DKD, NCT02545049; FIDELIO-DKD; Efficacy and Safety of Finerenone in Subjects with Type 2 Diabetes Mellitus and Diabetic Kidney Disease [NCT02540993])
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