Finerenone Improves Cardiovascular, Kidney, and CKM Outcomes among diabetics with CKD: JAMA
USA: Among patients with type 2 diabetes and chronic kidney disease, finerenone reduced the risk of cardiovascular and kidney events across all stages of cardiovascular-kidney-metabolic (CKM) syndrome, finds a new study. The treatment also promoted CKM syndrome regression and slowed disease progression over time, supporting its role in improving overall cardiometabolic and renal health.
The findings were published in JAMA Cardiology by Kevin Bryan Lo from Brigham and Women's Hospital and Harvard Medical School, along with colleagues.
Cardiovascular-kidney-metabolic syndrome is a recently recognized framework that highlights the interconnected nature of obesity, type 2 diabetes, chronic kidney disease (CKD), and cardiovascular disease. Patients with CKM syndrome face a heightened risk of adverse cardiovascular and renal outcomes, making effective therapies crucial for slowing disease progression and reducing complications.
To assess whether the benefits of finerenone vary according to CKM stage, researchers conducted a post hoc pooled analysis of the FIDELITY program, which combined data from two large phase 3 randomized, double-blind, placebo-controlled clinical trials conducted across 48 countries. The analysis included patients with type 2 diabetes and CKD who were receiving maximally tolerated renin-angiotensin system inhibitor therapy and had an estimated glomerular filtration rate of at least 25 mL/min/1.73 m².
A total of 12,990 participants were included in the analysis. The mean age was 64.8 years, and 30% were women. Based on American Heart Association criteria, 3,864 participants (30%) were classified as CKM stage 2, 3,275 (25%) as stage 3, and 5,851 (45%) as stage 4.
Key Findings:
- CKM stage 4 was associated with significantly higher cardiovascular and kidney event rates than CKM stage 2.
- Finerenone reduced cardiovascular event risk across all CKM stages.
- Finerenone reduced kidney event risk regardless of baseline CKM stage.
- Cardiovascular benefits were consistent across CKM stages 2, 3, and 4.
- Kidney benefits were consistent across CKM stages 2, 3, and 4.
- CKM syndrome regression was more common with finerenone than with placebo (11.4% vs 7.4%).
- Finerenone increased the likelihood of CKM syndrome regression.
- Finerenone reduced the likelihood of CKM syndrome progression.
- The treatment promoted favorable changes in the CKM syndrome stage over time.
- Finerenone improved both cardiovascular and kidney outcomes in patients with type 2 diabetes and chronic kidney disease.
The investigators noted that the analysis was not originally designed to evaluate CKM syndrome progression and that some data used for staging were not systematically collected, which may have led to underestimation of certain disease stages. Nevertheless, the findings were consistent across multiple analyses.
The researchers concluded that finerenone provides cardiovascular and kidney protection across the spectrum of CKM syndrome in patients with type 2 diabetes and chronic kidney disease. In addition to lowering the risk of adverse clinical outcomes, the therapy was associated with favorable changes in CKM syndrome evolution, supporting its potential role in comprehensive cardiometabolic and renal risk management.
Reference:
Lo KB, Ostrominski JW, Hamatani Y, et al. Finerenone Across Cardiovascular-Kidney-Metabolic Syndrome Stages: Post Hoc Analysis of the FIDELITY Randomized Clinical Trials. JAMA Cardiol. Published online June 03, 2026. doi:10.1001/jamacardio.2026.1365
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