This study states that Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) face substantial cardiovascular (CV) morbidity and mortality. Finerenone, a novel, nonsteroidal, selective, mineralocorticoid receptor antagonist (MRA), reduced the primary composite endpoint related to kidney failure outcomes in the FIDELIO-DKD trial. The effect of finerenone on overall CV outcomes, and specific CV outcomes in patients with and without prior history of CV disease (CVD) is the subject of this report. FIDELIO-DKD was a randomized, double-blind, placebo-controlled, multicenter phase III clinical trial. Patients with urine albumin-to-creatinine ratio (UACR) ≥30-<300 mg/g and eGFR ≥25-<60 mL/min/1.73 m2, with a history of diabetic retinopathy or UACR ≥300-≤5000 mg/g and eGFR ≥25-<75 mL/min/1.73 m2 were included. Patients were randomized 1:1 to receive either oral finerenone (at titrated doses of 10 mg or 20 mg once daily) or placebo. Prespecified CV outcomes included a composite endpoint of CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure. In a prespecified subgroup analysis, outcomes were analyzed by the presence or absence of a history of atherosclerotic CVD at baseline, defined as investigator-reported medical history of coronary artery disease, myocardial infarction, peripheral arterial disease, ischaemic stroke or carotid endarterectomy.

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