New research was presented at Kidney Week 2020 Reimagined, the virtual annual meeting of the American Society of Nephrology.
While albuminuria was shown to be reduced with finerenone in short-term trials of patients with chronic kidney disease (CKD) and type 2 diabetes, long-term effects of the agent on kidney and cardiovascular outcomes are unclear. Researchers conducting a double-blind trial randomly assigned patients with CKD and type 2 diabetes in a 1:1 ratio to finerenone or placebo. Participants 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. During a median follow-up of 2.6 years, the composite of kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes occurred in 17.8% of the finerenone group, compared with 21.1% of the placebo group (hazard ratio [HR], 0.82). The composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure occurred in 13.0% and 14.8% of the respective groups (HR, 0.86). While hyperkalemia-related discontinuation of the trial regimen was higher with finerenone (2.3% vs 0.9%), adverse event frequency was similar in both groups.