Finerenone lower risks of CKD progression and cardiovascular events

      In a double-blind trial, investigators observed the effect of Finerenone, a nonsteroidal, selective mineralocorticoid receptor antagonist in reducing albuminuria in patients with chronic kidney disease (CKD) and type 2 diabetes. The trial randomly assigned 5734 patients with CKD and type 2 to receive Finerenone or placebodiabetes in a 1:1 ratio. Eligible patients had a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 30 to less than 300, an estimated glomerular filtration rate (eGFR) of 25 to less than 60 ml per minute per 1.73 m2 of body-surface area, and diabetic retinopathy, or they had a urinary albumin-to-creatinine ratio of 300 to 5000 and an eGFR of 25 to less than 75 ml per minute per 1.73 m2. The primary composite outcome, assessed in a time-to-event analysis, was kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes and the secondary composite outcome assessed in a time-to-event analysis, was death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure.

During a median follow-up of 2.6 years, it was noticed that the primary outcome event occurred in 17.8% in the Finerenone group and 21.1% in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.93; P=0.001). Secondary outcome event occurred in 13.0% in the Finerenone group and 14.8% in the placebo group (hazard ratio, 0.86; 95% CI, 0.75 to 0.99; P=0.03).

The study concluded that in patients with CKD and type 2 diabetes, treatment with Finerenone resulted in lower risks of CKD progression and cardiovascular events than placebo.

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