The following is a summary of “Effect of avenciguat on albuminuria in patients with CKD two randomized placebo-controlled trials,” published in the May 2024 issue of Nephrology by Heerspink et al.

Avenciguat, a potent soluble guanylate cyclase activator, is being developed for chronic kidney disease (CKD).

Researchers conducted a retrospective study evaluating the effects of avenciguat on CKD, including patients with and without diabetes.

They conducted a pooled analysis of two identical trials, enrolling patients with CKD and eGFR ≥20 and <90 mL/min/1.73 m² with urine albumin-to-creatinine ratio (UACR) ≥200 and <3,500 mg/g. Participants received a placebo or avenciguat (1, 2, or 3 mg thrice a day, TID; adjunctive to angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker) for 20 weeks. The primary endpoint was UACR change from baseline in 10-hour urine at week 20. Safety was monitored throughout. 

The result showed 500 patients with mean age 62±13 years, mean eGFR 44±18 mL/min/1.73 m² and median 10-hour UACR 719 [IQR 379-1285] mg/g) received placebo (n=122) or avenciguat 1 mg (n=125), 2 mg (n=126), or 3 mg (n=127) TID. Avenciguat reduced UACR in 10-hour and first-morning void urine compared to the placebo. At week 20, UACR reductions with 1 mg avenciguat were 15.5% (-26.4, -3.0), with 2 mg -13.2% (-24.6, -0.1), and with 3 mg dosage -21.5% (-31.7, -9.8) in 10-hour urine; and -19.4% (-30.0, -7.3), -15.5% (-26.9, -2.5), and -23.4% (-33.5, -11.8) in first-morning void urine, respectively. Avenciguat was well-tolerated with low AEs. The number of patients who discontinued due to adverse events with avenciguat 1, 2, and 3 mg TID were 5(4%), 11(9%), and 11(9%), respectively. At the same time, only 4 patients discontinued in the placebo group. 

Investigators concluded that Avenciguat effectively reduced albuminuria in patients with CKD and was well tolerated.

Source: journals.lww.com/jasn/abstract/9900/effect_of_avenciguat_on_albuminuria_in_patients.331.aspx