Finerenone Reduces Heart Failure Risk in Patients With CKD, T2D

Study results demonstrate that finerenone (Kerendia) reduced the odds of developing heart failure (HF) and improved other HF-related outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) regardless of history of HF.

The study, published in Circulation, is the first to show that a nonsteroidal mineralocorticoid receptor antagonist (MRA) could benefit patients with early-stage CKD and T2D in regard to HF. The investigators said that patients should be screened for albuminuria and should receive early treatment to reduce the burden of HF in patients with CKD and T2D.

CKD and T2D are independently associated with HF, and patients with all 3 conditions are at greater risk of cardiovascular and noncardiovascular hospitalization and mortality compared with patients with 1 or none of the conditions. Management of patients with CKD, T2D, and HF is difficult because current guidelines for treatments often do not apply to patients with comorbid conditions and many glucose-lowering therapies should not be used in patients with CKD.

Finerenone is a selective, nonsteroidal MRA with evidence of positive effects on cardiovascular outcomes in patients with CKD and T2D. However, there has not been any prospective evaluation of the impact of MRAs on the prevalence or severity of HF in patients with CKD and/or T2D. Finerenone has also shown to be tolerable in patients with albuminuric CKD and T2D.

The investigators analyzed data that were collected as part of the FIGARO-DKD trial, an international, randomized, double-blind, placebo-controlled, multicenter, phase 3 study. To be eligible for inclusion, patients had to be 18 years or older, with a clinical diagnosis of T2D and albuminuric CKD. The patients were randomized 1:1 to received once-daily oral treatment with finerenone or placebo. The investigators examined 7 outcomes:

• Time to new-onset HF (first hospitalization for HF [HHF] in patients without a history of HF at baseline)
• A composite of time to cardiovascular death or first HHF
• A composite of time to HF-related death or first HHF
• Time to first HHF
• A composite of time to cardiovascular death or total (first or recurrent) HHF
• A composite of time to HF-related death or total HHF
• Time to total HHF

Overall, 7352 patients were randomized and analyzed. The median follow-up was 3.4 years, and 571 patients had a history of HF at baseline. Those with a HF history were more likely to be female, White, have a higher body mass index, have a higher level of high-sensitivity C-reactive protein, have a lower heart rate, and have a lower kidney filtration rate and median urine albumin-to-creatinine ratio.

Patients who received finerenone treatment had a 29% reduction in the risk of first HHF and an 18% reduction in their risk of cardiovascular death or first HHF compared with patients who were treated with a placebo. This trend persisted regardless of history of HF. Additionally, the risk of new-onset HF was 32% among patients receiving finerenone vs patients receiving placebo.

“The benefits of finerenone on HF outcomes observed in this study, including the prevention of HF and the reduction in time-to-first-event and total HHF, can be expected to translate into meaningful improvements in patient outcomes,” the investigators wrote.

The study had a few limitations, including the use of a definition for HF that was developed without a specification or consistent documentation of left ventricular ejection fraction or natriuretic peptide levels. Additionally, the sample size of patients with a history of HF was relatively small.

Reference

Filippatos G, Anker SD, Agarwal R, et al; FIGARO-DKD Investigators. Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes: analyses from the FIGARO-DKD trial. Circulation. 2022;145(6):437-447. doi:10.1161/CIRCULATIONAHA.121.057983