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Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes According to Baseline HbA1c and Insulin Use:
Peter Rossing1,2, Ellen Burgess3, Rajiv Agarwal4
1Steno Diabetes Center Copenhagen, Herlev, Denmark.
Insights
Finerenone benefits patients with type 2 diabetes and chronic kidney disease, improving cardiorenal outcomes. These benefits were consistent regardless of baseline HbA1c levels or insulin treatment.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Diabetic kidney disease (DKD) is a major complication of type 2 diabetes (T2D).
- Finerenone has demonstrated cardiorenal benefits in T2D patients with DKD.
- The influence of baseline glycemic control (HbA1c) and insulin use on these outcomes requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of finerenone in patients with T2D and chronic kidney disease (CKD).
- To determine if baseline HbA1c levels and insulin treatment modify the cardiorenal benefits of finerenone.
Main Methods:
- A randomized, placebo-controlled trial involving patients with T2D, CKD (eGFR 25–75 mL/min/1.73 m2), and albuminuria.
- Patients received optimized renin-angiotensin system blockade plus finerenone or placebo.
- Outcomes analyzed by baseline insulin use and HbA1c levels (<7.5% or ≥7.5%).
Main Results:
- Finerenone significantly reduced kidney and cardiovascular composite outcomes.
- Treatment benefits were consistent across subgroups defined by baseline HbA1c levels and insulin use (Pinteraction > 0.3).
- Higher baseline HbA1c was associated with increased cardiovascular risk, but finerenone's benefit remained.
Conclusions:
- Finerenone provides significant cardiorenal protection in patients with T2D and CKD.
- The efficacy of finerenone is not influenced by baseline HbA1c levels or insulin treatment status.
- These findings support finerenone's role in managing DKD across diverse patient profiles.
Objective:
Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes.
Research Design And Methods:
Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30-5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin-angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%.
Results:
Of 5,674 patients, 3,637 (64.1%) received insulin at baseline. Overall, 5,663 patients were included in the analysis for HbA1c; 2,794 (49.3%) had baseline HbA1c <7.5% (58 mmol/mol). Finerenone significantly reduced risk of the kidney composite outcome independent of baseline HbA1c level and insulin use (Pinteraction = 0.41 and 0.56, respectively). Cardiovascular composite outcome incidence was reduced with finerenone irrespective of baseline HbA1c level and insulin use (Pinteraction = 0.70 and 0.33, respectively). Although baseline HbA1c level did not affect kidney event risk, cardiovascular risk increased with higher HbA1c level. UACR reduction was consistent across subgroups. Adverse events were similar between groups regardless of baseline HbA1c level and insulin use; few finerenone-treated patients discontinued treatment because of hyperkalemia.
Conclusions:
Finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2D, and risks appear consistent irrespective of HbA1c levels or insulin use.
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