Finerenone treatment lowered the risk of chronic kidney disease (CKD) progression, as well as the risk of cardiovascular (CV) events in patients diagnosed with type 2 diabetes and advanced CKD, according to a study published in the New England Journal of Medicine. Dubbed the FIDELIO-DKD trial, the study tested the efficacy of finerenone—a nonsteroidal, selective mineralocorticoid receptor antagonist that reduces urinary albumin-tocreatinine ratio in patients with CKD previously treated with a renin-angiotensin system (RAS) inhibitor—in slowing CKD progression and reducing CV events in patients diagnosed with advanced CKD and type 2 diabetes. FIDELIODKD randomized 5,734 participants across 48 countries to receive either a once-daily dose of 20 mg oral finerenone or placebo. Adults with type 2 diabetes and CKD who were treated with a RAS inhibitor at the maximum dose were eligible. The primary endpoint was a composite of kidney failure, sustained estimated glomerular filtration rate (eGFR) decrease of at least 40% for at least 4 weeks, or death from renal causes. Kidney failure was defined as endstage kidney disease with an eGFR less than 15 mL/minute/1.73m2. After a median follow-up of 2.6 years, the primary endpoint had occurred in 17.8% of the finerenone group, compared with 21.1% in the control group. The number of participants requiring finerenone treatment to prevent one primary outcome was 29. Additionally, death from CV causes, non-fatal myocardial infarctions, nonfatal stroke, or hospitalization due to heart failure occurred in 13.0% of the finerenone group, compared with 14.8% of the placebo group. The incidence of serious adverse events was similar between both groups: 31.9% in the finerenone group and 34.3% in the placebo group. Specifically, hyperkalemia-related adverse events were twice as frequent in the finerenone group (18.3%) versus the placebo group (9.0%).

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