Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes

This phase 3 randomized controlled trial (FIGARO-DKD) evaluated finerenone—a selective nonsteroidal mineralocorticoid receptor antagonist in 7437 patients with type 2 diabetes and either stage 2–4 chronic kidney disease (CKD) with moderately elevated albuminuria or stage 1–2 CKD with severely elevated albuminuria. Over a median follow-up of 3.4 years, finerenone significantly reduced the risk of the primary composite outcome: cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (HR 0.87; P=0.03). Benefits were driven mainly by fewer hospitalizations for heart failure. Secondary kidney outcomes showed numerical improvements but did not reach statistical significance. The trial confirmed a favorable safety profile, with hyperkalemia more frequent with finerenone but rarely leading to hospitalization or discontinuation. Results support finerenone’s use to mitigate cardiovascular risk in diabetic CKD populations not covered by previous trials.

This phase 3 randomized controlled trial (FIGARO-DKD) evaluated finerenone—a selective nonsteroidal mineralocorticoid receptor antagonist in 7437 patients with type 2 diabetes and either stage 2–4 chronic kidney disease (CKD) with moderately elevated albuminuria or stage 1–2 CKD with severely elevated albuminuria. Over a median follow-up of 3.4 years, finerenone significantly reduced the risk of the primary composite outcome: cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (HR 0.87; P=0.03). Benefits were driven mainly by fewer hospitalizations for heart failure. Secondary kidney outcomes showed numerical improvements but did not reach statistical significance. The trial confirmed a favorable safety profile, with hyperkalemia more frequent with finerenone but rarely leading to hospitalization or discontinuation. Results support finerenone’s use to mitigate cardiovascular risk in diabetic CKD populations not covered by previous trials.