Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes

This double blind, placebo-controlled trial evaluated the cardiovascular effects of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in 7,437 patients with type 2 diabetes and chronic kidney disease (CKD). Over a median follow up of 3.4 years, finerenone significantly reduced the primary composite outcome of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (12.4% vs. 14.2%; hazard ratio, 0.87; 95% CI, 0.76–0.98; P=0.03), driven primarily by a lower incidence of heart failure hospitalization. The secondary kidney composite outcome (kidney failure, sustained eGFR decline ≥40%, or renal death) showed a nonsignificant trend toward benefit (9.5% vs. 10.8%; hazard ratio, 0.87; 95% CI, 0.76–1.01). Hyperkalemia occurred more frequently with finerenone (10.8% vs. 5.3%), but discontinuation rates were low (1.2% vs. 0.4%). The findings support finerenone as a cardioprotective therapy for high risk patients with type 2 diabetes and CKD.

This double blind, placebo-controlled trial evaluated the cardiovascular effects of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in 7,437 patients with type 2 diabetes and chronic kidney disease (CKD). Over a median follow up of 3.4 years, finerenone significantly reduced the primary composite outcome of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (12.4% vs. 14.2%; hazard ratio, 0.87; 95% CI, 0.76–0.98; P=0.03), driven primarily by a lower incidence of heart failure hospitalization. The secondary kidney composite outcome (kidney failure, sustained eGFR decline ≥40%, or renal death) showed a nonsignificant trend toward benefit (9.5% vs. 10.8%; hazard ratio, 0.87; 95% CI, 0.76–1.01). Hyperkalemia occurred more frequently with finerenone (10.8% vs. 5.3%), but discontinuation rates were low (1.2% vs. 0.4%). The findings support finerenone as a cardioprotective therapy for high risk patients with type 2 diabetes and CKD.