Kidney outcomes with finerenone: an analysis from the FIGARO-DKD study

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Finerenone has demonstrated cardiovascular benefits in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) stages 1-4 (FIGARO-DKD) and advanced CKD (FIDELIO-DKD).
• This analysis specifically investigates kidney outcomes within the FIGARO-DKD study population.

Purpose of the Study:

• To further explore the kidney outcomes associated with finerenone treatment in patients with T2D and varying stages of CKD.
• To assess the efficacy of finerenone in reducing kidney disease progression and cardiovascular events.

Main Methods:

• The FIGARO-DKD trial enrolled patients with T2D and CKD, defined by specific urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) ranges.
• Key kidney endpoints included a composite of ≥40% eGFR decrease or kidney failure/renal death, and a composite of ≥57% eGFR decrease or kidney failure/renal death.
• Albuminuria changes, eGFR slope, and cardiovascular outcomes were analyzed, stratified by baseline UACR levels.

Main Results:

• Finerenone showed a non-significant trend towards reducing the composite endpoint of a ≥40% eGFR decrease (HR=0.87; P=0.069).
• A significant reduction was observed for the composite endpoint of a ≥57% eGFR decrease, kidney failure, or renal death (HR=0.77; P=0.041), indicating a 36% relative risk reduction for end-stage kidney disease.
• Greater benefits on kidney outcomes were noted in patients with severely increased albuminuria compared to those with moderately increased albuminuria. Improvements in UACR, eGFR slope, and cardiovascular risk were observed across subgroups.

Conclusions:

• Finerenone demonstrates a protective effect against kidney disease progression in patients with T2D and CKD.
• The findings support finerenone's role in mitigating both kidney and cardiovascular risks in this patient population.