Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes
Finerenone is a nonsteroidal, selective mineralocorticoid receptor antagonist. The short-term use of Finerenone, in patients with chronic kidney disease (CKD) and type 2 diabetes, have shown a reduction in albuminuria. But the long-term effect of finerenone on the kidney and the cardiovascular outcome is not known. Bakris and colleagues (2020) conducted a double-blind trial titled “Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes” published in “The New England Journal of Medicine”. The study is summarized below:
Objective:
To investigate the outcome of the hypothesis that finerenone slows CKD progression and helps to reduce cardiovascular morbidity and mortality in patients diagnosed with advanced CKD and type 2 diabetes.
Method:
Participants were selected as per the eligibility criteria. 5734 patients with CKD and type 2 diabetes were randomly assigned for treatment with finerenone or placebo. A treatment involving a maximum dose of renin-angiotensin system blockade that does not cause any unacceptable side effect was provided to all patients.
The primary composite outcome included kidney failure, a decrease in GFRs of at least 40% from baseline, death due to renal cause. The secondary composite outcome included death from a cardiovascular cause, nonfatal myocardial infection or stroke, and hospitalization due to heart failure.
Findings:
The study suggests finerenone as an effective treatment for cardiovascular and renal protection as it resulted in better primary and secondary outcomes when compared to patients receiving a placebo. The study observed positive cardiovascular outcomes in as early as 1 month with finerenone treatment. On the other hand, kidney events were improved within 12 months. The study highlights that both these positive outcomes remained consistent throughout the trial. Authors add that anti-inflammatory and antifibrotic effect due to inhibition of overactivation of the mineralocorticoid receptor is responsible for kidney and cardiovascular benefits of finerenone.
Limitations:
Patients with advanced CKD, with non-albumin uric CKD, and those with CKD not caused by Type 2 diabetes were excluded. Due to this, the authors acknowledge that these findings may not be suitable to generalize for all. Ongoing Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial will provide further insights about cardiorenal effectiveness and safety of finerenone in patients with type 2 diabetes and less advanced CKD.
Image Credit: Hand photo created by jcomp – www.freepik.com