In a subanalysis of the FIDELITY trial, investigators explored the potential for modifying cardiovascular risk in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) using finerenone. The analysis included 13,026 participants with T2D and CKD who were randomly assigned to receive finerenone or placebo. Lower estimated glomerular filtration rate (eGFR) and higher albuminuria were associated with increased incidences of cardiovascular events. However, the study revealed that finerenone was associated with a reduction in composite cardiovascular risk across all eGFR and albuminuria categories.
The analysis demonstrated that patients in the placebo group with higher eGFR and albuminuria had higher incidence of cardiovascular events. In contrast, finerenone treatment was associated with a decreased risk of composite cardiovascular events, irrespective of eGFR and albuminuria levels. In a simulation analysis, 1 year of finerenone treatment was estimated to prevent 38,359 cardiovascular events. Interestingly, a significant proportion prevented in patients with eGFR of 60 or greater. These findings suggest that finerenone treatment may modify the CKD-associated cardiovascular risk in patients with T2D. In particular, patients with higher eGFR and albuminuria may benefit from this.
The subanalysis emphasizes the potential population-level benefits of identifying patients with T2D and albuminuria with eGFR of 60 or greater through urine albumin to creatinine ratio (UACR) screening. By targeting this specific population, significant reductions in cardiovascular events, including hospitalizations for heart failure, can be achieved with finerenone treatment. These findings provide valuable insights into the modifiability of CKD-associated cardiovascular risk. Furthermore, the study highlights the importance of considering finerenone as a potential treatment option for T2D patients with CKD. Further research and clinical trials are necessary to validate and expand upon these encouraging results.
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Original article: Agarwal R et al. JAMA Cardiol. 2023 June 14. doi:10.1001/jamacardio.2023.1505
