What is the clinical evidence from this study?

Study design: Review. Population: Diabetic nephropathy. Intervention: Finerenone.

May 29, 2021Diabetes TherapyOpen Access

The Role of Finerenone in the Management of Diabetic Nephropathy

Q: What does this research mean for the field?

Finerenone reduces the incidence of the primary composite kidney outcome by 18% compared to placebo in patients with type 2 diabetes and chronic kidney disease. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Finerenone reduces composite kidney events ~18% vs placebo in patients with T2D and CKD.

Why the study?

Traditional MRAs added to ACE inhibitors or ARBs increase hyperkalemia risk, so more data are needed to clarify the safety and efficacy of finerenone in diabetic nephropathy.

Does finerenone reduce kidney failure and disease progression in patients with type 2 diabetes mellitus and chronic kidney disease?

Structured PICO

Does finerenone reduce kidney failure and disease progression in patients with type 2 diabetes mellitus and chronic kidney disease?

Population

5,734 patients with type 2 diabetes mellitus and chronic kidney disease (defined as UACR 30–300 mg/g, eGFR 25–60 ml/min/1.73 m2, and a history of diabetic retinopathy or as UACR 300–5000 mg/g and eGFR 25–75 ml/min/1.73 m2) treated with ACE-Is or ARBs at the maximum tolerated dose and with serum potassium level of at most 4.8 mmol/l, multinational (48 countries).

Intervention

Finerenone 20 mg/day (10 mg/day in patients with eGFR 25–60 ml/min/1.73 m2)

Comparator

Placebo

Outcome

Composite of kidney failure (defined as initiation of long-term dialysis for at least 90 days, kidney transplantation, or eGFR less than 15 ml/min/1.73 m2), sustained decrease of at least 40% in the eGFR from baseline over a period of at least 4 weeks, or death from renal causescomposite

Finerenone delays the progression of diabetic nephropathy and reduces cardiovascular morbidity in patients with type 2 diabetes mellitus, representing a useful therapeutic option despite an increased risk of hyperkalemia.

Limitations

More data are needed to clarify the safety and efficacy of finerenone in this high-risk population.
Finerenone increases the incidence of hyperkalemia, requiring close follow-up in patients treated with a combination of finerenone and ACE-Is or ARBs.

Implication

May support finerenone consideration in T2DM-CKD; leaves open confirmation via prospective RCTs.

Abstract

Diabetic nephropathy (DN) is the leading cause of chronic kidney disease. Even though mineralocorticoid receptor antagonists (MRA) induce incremental reductions in urine albumin excretion when added to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, this combination is infrequently used because of an increased risk of hyperkalemia. In this context, finerenone, a novel selective MRA that appears to be associated with lower risk for hyperkalemia compared with other MRAs (spironolactone and eplerenone), might represent a useful tool in patients with DN. A recent large randomized trial suggested that finerenone delays the progression of DN and might also reduce cardiovascular morbidity in patients with DN. However, more data are needed to clarify the safety and efficacy of finerenone in this high-risk population.

Discussion

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Cite This Study

Veneti et al. (2021) conducted a review in Diabetic nephropathy. Finerenone was evaluated. Finerenone reduced the incidence of the primary composite kidney outcome by 18% compared to placebo in patients with type 2 diabetes and chronic kidney disease.

synapsesocial.com/papers/6a158eedcb801b7f954ea691 https://doi.org/10.1007/s13300-021-01085-z

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Implication

May support finerenone consideration in T2DM-CKD; leaves open confirmation via prospective RCTs.

The Role of Finerenone in the Management of Diabetic Nephropathy

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

The Role of Finerenone in the Management of Diabetic Nephropathy

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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