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Publications

Journal Article Ahead of print

PubMed: 42803273 DOI: 10.1093/ejhf/xuag299

Effectiveness of Finerenone in Slowing Chronic Kidney Disease Progression After Hospitalization for Heart Failure: A FIDELITY Subgroup Analysis.

Eur J Heart Fail

Authors: Tariq Shafi, Stefan D Anker, Bertram Pitt, Luis M Ruilope, Peter Rossing, Meike Brinker, Katja Rohwedder, Charlie Scott, Youssef M K Farag, Gerasimos Filippatos

Affiliations

  • Division of Nephrology, Baylor Scott & White Health, Temple, TX, USA.
  • Department of Cardiology (CVK) of German Heart Center Charité; German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany.
  • Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.
  • Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain.
  • CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Faculty of Sport Sciences, European University of Madrid, Madrid, Spain.
  • Steno Diabetes Center, Copenhagen, Denmark.
  • Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  • Cardiology and Nephrology Clinical Development, Bayer AG, Wuppertal, Germany.
  • Clinical Statistics and Analytics, Bayer Corporation, Houston, TX, USA.
  • Postgraduate Medical Education, Harvard Medical School, Boston, MA, USA.
  • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece.

Abstract

BACKGROUND

Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces risk of heart and kidney outcomes in people with chronic kidney disease (CKD) and type 2 diabetes (T2D). Heart failure is the leading cause of hospitalization in patients with CKD. Here we evaluated whether the reduction in estimated glomerular filtration rate (eGFR) decline (CKD progression) with finerenone persists after hospitalization for heart failure (HHF).

METHODS AND RESULTS

This post hoc analysis utilized the FIDELITY dataset pooled from the phase 3 FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049) trials, comprising adults with CKD and T2D on optimized renin-angiotensin system inhibitor treatment, randomized 1:1 to finerenone or placebo. Participants included experienced HHF between 4 months post randomization and study end. The key outcome was change in chronic eGFR slope (eGFR estimated from serum creatinine) before and after HHF. To avoid confounding from serum creatinine changes preceding and following HHF, eGFR values ±90 (primary analysis), ±120, and ±150 days from HHF were excluded. Baseline characteristics, medications, and mean hospital stay length were generally balanced between treatment groups. For the primary analysis, both the pre-HHF and post-HHF mean change in eGFR declined slower with finerenone versus placebo (between-group difference 2.68 mL/min/1.73 m2/year [95% confidence interval [CI], 0.87 to 4.49] pre-HHF and 0.96 mL/min/1.73 m2/year [95% CI, -0.99 to 2.91] post-HHF).

CONCLUSION

Treatment with finerenone is associated with clinically meaningful attenuation of CKD progression in people with CKD and T2D before HHF, and persists post-HHF, suggesting that maintaining finerenone after HHF may continue to confer benefits in attenuating CKD progression.

MeSH

Kidney Diseases, Creatinine, Hospitalization, Serum, Heart Failure, Heart, Disease Progression, Kidney, Therapeutics