Key result
Finerenone slows pre-HHF eGFR decline by ~2.7 mL/min/1.73 m2/year vs placebo in CKD and T2D.
Why the study?
It was uncertain whether finerenone's effect in reducing eGFR decline in CKD and T2D patients persists after hospitalization for heart failure.
Does finerenone slow chronic kidney disease progression in adults with CKD and T2D who experience hospitalization for heart failure?
RCT
1:1
Does finerenone slow chronic kidney disease progression in adults with CKD and T2D who experience hospitalization for heart failure?
Mean Difference: 2.68 (95% CI 0.87–4.49)
Finerenone attenuates CKD progression in patients with CKD and T2D both before and after a hospitalization for heart failure, suggesting continued benefit of the therapy.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Patients treated with finerenone tended to have lower eGFR decline after a hospitalization due to HF event when compared to placebo. Our findings suggest that finerenone should be continued on discharge in patients experiencing a hospitalization due to HF event.”
May support continuing finerenone after HHF in CKD with T2D; extends prior eGFR slope benefit to the post-hospitalization period.
BACKGROUND: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces risk of heart and kidney outcomes in people with chronic kidney disease (CKD) and type 2 diabetes (T2D). Heart failure is the leading cause of hospitalization in patients with CKD. Here we evaluated whether the reduction in estimated glomerular filtration rate (eGFR) decline (CKD progression) with finerenone persists after hospitalization for heart failure (HHF). METHODS AND RESULTS: This post hoc analysis utilized the FIDELITY dataset pooled from the phase 3 FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049) trials, comprising adults with CKD and T2D on optimized renin-angiotensin system inhibitor treatment, randomized 1:1 to finerenone or placebo. Participants included experienced HHF between 4 months post randomization and study end. The key outcome was change in chronic eGFR slope (eGFR estimated from serum creatinine) before and after HHF. To avoid confounding from serum creatinine changes preceding and following HHF, eGFR values ±90 (primary analysis), ±120, and ±150 days from HHF were excluded. Baseline characteristics, medications, and mean hospital stay length were generally balanced between treatment groups. For the primary analysis, both the pre-HHF and post-HHF mean change in eGFR declined slower with finerenone versus placebo (between-group difference 2.68 mL/min/1.73 m2/year [95% confidence interval [CI], 0.87 to 4.49] pre-HHF and 0.96 mL/min/1.73 m2/year [95% CI, -0.99 to 2.91] post-HHF). CONCLUSION: Treatment with finerenone is associated with clinically meaningful attenuation of CKD progression in people with CKD and T2D before HHF, and persists post-HHF, suggesting that maintaining finerenone after HHF may continue to confer benefits in attenuating CKD progression.
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Shafi et al. (2026) conducted an RCT in Chronic kidney disease (CKD) and type 2 diabetes (T2D). Finerenone vs. Placebo was evaluated on Change in chronic eGFR slope before and after hospitalization for heart failure (MD 2.68 mL/min/1.73 m2/year (pre-HHF), 95% CI 0.87 to 4.49). Finerenone attenuated eGFR decline compared to placebo before (difference 2.68 mL/min/1.73 m2/year) and after (difference 0.96) hospitalization for heart failure in patients with CKD and T2D.
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