Finerenone improves kidney outcomes in patients of CKD with diabetes: Study
Delhi: Finerenone exerts renoprotective benefits in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) irrespective of absence or presence of SGLT2 inhibitors, suggests data from FIDELIO-DKD analysis. Furthermore, the addition of finerenone to SGLT2i results in a greater urine albumin-to-creatinine ratio (UACR) reduction.
The findings of the study were presented at the American Diabetes Association 81st Scientific Sessions (ADA 2021).
FIDELIO-DKD trial investigated the selective, nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with CKD and T2D. Sodium-glucose co-transporter-2 inhibitors (SGLT-2is) are recommended for CKD in T2D patients for reducing CKD progression. Peter Rossing, Head of Complications Research and Chief Physician at Steno Diabetes Center in Copenhagen, and colleagues reported a predefined exploratory analysis of patients by SGLT-2i use.
The study included patients (N=5674) with T2D, urine albumin-to-creatinine ratio (UACR) 30-5000 mg/g and estimated glomerular filtration rate (eGFR) 25-<75 mL/min/1.73 m2 receiving optimized RAS blockade. They were randomized to finerenone (10 mg daily increasing to 20 mg daily) or placebo.
Of 5674 patients, 4.6% received SGLT-2i at baseline.
Key findings of the study include:
- Overall, finerenone significantly reduced the primary (time to kidney failure, sustained decrease in eGFR ≥40% from baseline, or renal death) and key secondary CV outcomes (time to CV death, nonfatal MI, nonfatal stroke, or hospitalization for heart failure) vs. placebo with no effect on A1C.
- Results were consistent irrespective of SGLT-2i use at baseline for the primary and key secondary CV outcomes.
- Reduction in UACR with finerenone was seen without SGLT-2i use (ratio of LS-means 0.68, 0.65-0.71) and on top of SGLT-2is at baseline (ratio of LS-means 0.75, 0.62-0.90).
- Treatment-emergent hyperkalemia events were fewer with SGLT-2i vs. no SGLT-2i (post hoc analysis).
"Our findings show that the benefits of finerenone on kidney and CV outcomes in patients with CKD and T2D appear consistent in the absence or presence of SGLT2i, with UACR improvement observed in patients already receiving SGLT-2i at baseline," concluded the authors.
"Finerenone in Patients with CKD and T2D by SGLT2i Treatment: An Analysis of the FIDELIO-DKD Study," was presented at the American Diabetes Association 81st Scientific Sessions (ADA 2021).