Key result
Finerenone cuts major CV events ~14% vs. placebo in T2D and CKD.
Why the study?
Persons with diabetes and CKD have a high residual risk of CV complications despite treatment with RAS blockers and SGLT2 inhibitors.
Does finerenone reduce cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease?
Does finerenone reduce cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease?
Hazard Ratio: 0.86 (95% CI 0.78–0.95)
Finerenone provides significant cardiorenal protection in patients with type 2 diabetes and chronic kidney disease, addressing residual risk beyond standard therapies.
May support finerenone for residual cardiorenal risk in type 2 diabetes with CKD; leaves open optimal integration with standard therapies.
Persons with diabetes and chronic kidney disease (CKD) have a high residual risk of developing cardiovascular (CV) complications despite treatment with renin-angiotensin system blockers and sodium-glucose cotransporter type 2 inhibitors. Overactivation of mineralocorticoid receptors plays a key role in the progression of renal and CV disease, mainly by promoting inflammation and fibrosis. Finerenone is a nonsteroidal selective mineralocorticoid antagonist. Recent clinical trials, such as FIDELIO-DKD and FIGARO-DKD and the combined analysis FIDELITY have demonstrated that finerenone decreases albuminuria, risk of CKD progression, and CV risk in subjects with type 2 diabetes (T2D) and CKD. As a result, finerenone should thus be considered as part of a holistic approach to kidney and CV risk in persons with T2D and CKD. In this narrative review, the impact of finerenone treatment on the CV system in persons with type 2 diabetes and CKD is analyzed from a practical point of view.Key messages:Despite inhibition of renin-angiotensin system and sodium-glucose cotransporter type 2, persons with type 2 diabetes (T2D) and chronic kidney disease (CKD) remain on high cardiovascular (CV) residual risk.Overactivation of mineralocorticoid receptors plays a key role in the progression of renal and CV disease, mainly by promoting inflammation and fibrosis that is not targeted by traditional treatments.Finerenone is a nonsteroidal selective mineralocorticoid antagonist that decreases not only albuminuria, but also the risk of CKD progression, and CV risk in subjects with T2D and CKD.
No takes yet. Share an insight, caveat, or question.
González‐Juanatey et al. (2023) conducted a review in Type 2 diabetes and chronic kidney disease (n=12,999). Finerenone vs. Placebo was evaluated on Composite CV primary variable (time to first CV death, nonfatal MI, non-fatal stroke, or HF hospitalization) (HR 0.86, 95% CI 0.78-0.95). Finerenone decreases albuminuria, the risk of chronic kidney disease progression, and cardiovascular risk in subjects with type 2 diabetes and chronic kidney disease.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: