Key result
Finerenone was associated with a significantly lower risk of major adverse cardiovascular events compared with spironolactone (HR 0.74) in patients with chronic kidney disease and type 2 diabetes.
Why the study?
The comparative effectiveness of finerenone and spironolactone in chronic kidney disease with type 2 diabetes remains unclear.
Does finerenone reduce major adverse cardiovascular events compared to spironolactone in adults with chronic kidney disease and type 2 diabetes?
Population
2268 propensity score-matched adults with CKD (eGFR 15-60 mL/min/1.73 m2) and T2D
Comparison
Finerenone vs spironolactone
Design
Target trial emulation using global real-world data from TriNetX
Follow-up
Median 1.3 years
Authors
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May support finerenone preference in CKD-T2D; leaves open need for confirmatory RCTs.
Cohort (n=2,268)
Yes
Does finerenone reduce major adverse cardiovascular events compared to spironolactone in adults with chronic kidney disease and type 2 diabetes?
Hazard Ratio: 0.74 (95% CI 0.58–0.94)
Absolute Event Rate: 9.9% vs 13.3%
Absolute Risk Reduction: 3%
Number Needed to Treat: 29
p-value: p=0.013
In a real-world target trial emulation, finerenone was associated with lower risks of mortality, cardiorenal events, and hyperkalemia compared to spironolactone in patients with CKD and T2D.
Wang et al. (2025) conducted a cohort in Chronic kidney disease and type 2 diabetes (n=2,268). Finerenone vs. Spironolactone was evaluated on Major adverse cardiovascular events (MACE) (HR 0.74, 95% CI 0.58-0.94, p=0.013). Finerenone was associated with a significantly lower risk of major adverse cardiovascular events compared with spironolactone (HR 0.74) in patients with chronic kidney disease and type 2 diabetes.
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