TY - JOUR
TI - Finerenone in Predominantly Advanced CKD and Type 2 Diabetes With or
Without Sodium-Glucose Cotransporter-2 Inhibitor Therapy
AU - Rossing, Peter
AU - Filippatos, Gerasimos
AU - Agarwal, Rajiv
AU - Anker,
AU - Stefan D.
AU - Pitt, Bertram
AU - Ruilope, Luis M.
AU - Chan, Juliana C. N.
AU - and Kooy, Adriaan
AU - McCafferty, Kieran
AU - Schernthaner, Guntram and
AU - Wanner, Christoph
AU - Joseph, Amer
AU - Scheerer, Markus F.
AU - Scott,
AU - Charlie
AU - Bakris, George L.
JO - Kidney International Reports
PY - 2022
VL - 7
TODO - 1
SP - 36-45
PB - EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
SN - 2468-0249
TODO - 10.1016/j.ekir.2021.10.008
TODO - albuminuria; chronic kidney disease; finerenone; sodium-glucose
cotransporter-2 inhibitors; type 2 diabetes
TODO - Introduction: FIDELIO-DKD (Finerenone in reducing kiDnEy faiLure and
disease prOgression in Diabetic Kidney Disease) investigated the
nonsteroidal, selective mineralocorticoid receptor (MR) antagonist
finerenone in patients with CKD and type 2 diabetes (T2D). This analysis
explores the impact of use of sodiumglucose cotransporter-2 inhibitor
(SGLT-2i) on the treatment effect of finerenone.
Methods: Patients (N = 5674) with T2D, urine albumin-to-creatinine ratio
(UACR) of 30 to 5000 mg/g and estimated glomerular filtration rate
(eGFR) of 25 to <75 ml/min per 1.73 m(2) receiving optimized
reninangiotensin system (RAS) blockade were randomized to finerenone or
placebo. Endpoints were change in UACR and a composite kidney outcome
(time to kidney failure, sustained decrease in eGFR >= 40% from
baseline, or renal death) and key secondary cardiovascular outcomes
(time to cardiovascular death, nonfatal myocardial infarction, nonfatal
stroke, or hospitalization for heart failure) (ClinicalTrials.gov,
NCT02540993).
Results: Of 5674 patients, 259 (4.6%) received an SGLT-2i at baseline.
Reduction in UACR with finerenone was found with or without use of
SGLT-2i at baseline, with ratio of least-squares means of 0.69 (95% CI
= 0.66-0.71) and 0.75 (95% CI -= 0.62-0.90), respectively
(P-interaction = 0.31). Finerenone also significantly reduced the kidney
and key secondary cardiovascular outcomes versus placebo; there was no
clear difference in the results by SGLT-2i use at baseline
(P-interaction = 0.21 and 0.46, respectively) or at any time during the
trial. Safety was balanced with or without SGLT-2i use at baseline, with
fewer hyperkalemia events with finerenone in the SGLT-2i group (8.1%
vs. 18.7% without).
Conclusion: UACR improvement was observed with finerenone in patients
with CKD and T2D already receiving SGLT-2is at baseline, and benefits on
kidney and cardiovascular outcomes appear consistent irrespective of use
of SGLT-2i.
ER -