Publications
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Mineralocorticoid Receptor Antagonist Use in Chronic Kidney Disease with Type 2 Diabetes: A Clinical Practice Document by the European Renal Best Practice (ERBP) Board of the European Renal Association (ERA)
Clin Kidney J. 2023;16:1885–1907
Patients with CKD and T2D are at high risk of both developing kidney failure and of CV events. With RAS blockers, residual risk of CKD progression remains high and no significant reduction in CV events and mortality has been seen in major studies in patients with CKD and T2D. Steroidal MRAs have been shown to reduce albuminuria in individuals on RAS monotherapy, but widespread clinical use is limited by the risk of hyperkalaemia and the absence of trials with hard renal outcomes. In recent years, non-steroidal MRAs have received increasing interest due to their better pharmacological profile, particularly finerenone, which effectively reduced CKD progression and CV outcomes in participants with T2D in Phase 3 trials.
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Efficacy of Finerenone in Patients with Type 2 Diabetes, Chronic Kidney Disease and Altered Markers of Liver Steatosis and Fibrosis: A FIDELITY Subgroup Analysis
Diabetes Obes Metab. 2023; online ahead of print DOI: 10.1111/dom.15305
This post hoc subgroup analysis from FIDELITY investigated the effect of finerenone on liver function, cardiovascular and kidney composite outcomes in patients with CKD and T2D, stratified by their risk of liver steatosis, inflammation and fibrosis.
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The Impact of Obesity on Cardiovascular and Kidney Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Treated with Finerenone: Post hoc analysis of the FIDELITY Study
Diabetes Obes Metab. 2023 doi Epub ahead of print : 10.1111/dom.15197
Patients with obesity may benefit more from treatment with mineralocorticoid receptor antagonists given their higher levels of circulating aldosterone and therefore potentially higher levels of MRs in visceral fat. The aim of this analysis was to assess the effect of finerenone on the risk of cardiovascular and kidney outcomes in patients with chronic kidney disease and type 2 diabetes, with and without obesity.
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Benefits and Harms of Drug Treatment for Type 2 Diabetes: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials
BMJ 2023;381:e074068 DOI 10.1136/bmj-2022-074068
Keeping abreast of the rising volume of randomized trials in adults with type 2 diabetes presents a formidable task. Recent randomized trials have shown cardiovascular and kidney advantages with finerenone, an innovative non-steroidal mineralocorticoid receptor antagonist, and weight loss with tirzepatide, a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GLP-1) receptor agonist.
Outcomes with Finerenone in Participants with Stage 4 CKD and Type 2 Diabetes: A FIDELITY Subgroup Analysis
Clin J Am Soc Nephrol. 2023; online ahead of print DOI: 10.2215/CJN.0000000000000149
Patients with stage 4 CKD and T2D have limited treatment options to reduce their persistent CV and kidney risk. This post hoc analysis of the FIDELITY database evaluated the effect of finerenone vs placebo in 890 patients with stage 4 CKD and T2D.
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Effects of Finerenone in Persons with CKD and T2D are Independent of HbA1c at Baseline, HbA1c Variability, Diabetes Duration and Insulin Use at Baseline
Diabetes Obes Metab. 2023; online ahead of print DOI: 10.1111/dom.14999
Given the role of HbA1c, diabetes duration and insulin use in determining morbidity and mortality of CKD in T2D, it is important to investigate whether these factors modify the efficacy and safety of therapies that mitigate the cardiorenal impact of CKD in T2D. This post hoc analysis of the FIDELITY database evaluated the effect of finerenone by baseline HbA1c, HbA1c variability, diabetes duration and baseline insulin use on cardiorenal outcomes and diabetes progression.
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Effect of Finerenone on Ambulatory Blood Pressure in Chronic Kidney Disease in Type 2 Diabetes
J Hypertens. 2023;41:295–302 DOI: 10.1097/HJH.0000000000003330
It has been postulated that the effects of finerenone on cardiorenal outcomes may be mediated primarily via non-haemodynamic pathways, but office BP measurements are insufficient to fully assess haemodynamic effects. A substudy of the ARTS-DN phase IIb trial was conducted to obtain further insights into the mechanism of action of finerenone by analysing 24-h ambulatory BP in patients with CKD and T2D.
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Finerenone efficacy in patients with chronic kidney disease, type 2 diabetes and atherosclerotic cardiovascular disease
Eur Heart J Cardiovasc Pharmacother. 2022; online ahead of print DOI: 10.1093/ehjcvp/pvac054
Finerenone reduced the risk of CV and kidney outcomes consistently across the spectrum of CKD in patients with T2D, irrespective of prevalent ASCVD.
Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease
Front Pharmacol. 2022;13:967317 DOI: 10.3389/fphar.2022.967317
A network meta-analysis has found that newer mineralocorticoid receptor antagonists (MRAs) appear to have greater efficacy in reducing urine albumin creatinine ratio (UACR) vs baseline than traditional MRAs in the treatment of diabetic kidney disease (DKD).
Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes by Sodium–Glucose Cotransporter 2 Inhibitor Treatment: The FIDELITY Analysis
Diabetes Care 2022; online ahead of print doi: 10.2337/dc22-0294
In the FIDELITY analysis, finerenone reduced the risk of cardiovascular and kidney outcomes compared with placebo. Concomitant treatment with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) did not modify the observed benefits.
FIDELITY pooled populations from the FIDELIO-DKD and FIGARO-DKD studies in order to examine the effect of finerenone and interaction with SGLT2i use on prespecified outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). In both trial, use of SGLT2i was permitted at baseline, as was initiation of SGLT2i at any time during the trial.