Finerenone in Predominantly Advanced CKD and Type 2 Diabetes With or Without Sodium-Glucose Cotransporter-2 Inhibitor Therapy
Diabetes is a leading cause of various complications, one of them being Chronic Kidney Disease. A comprehensive treatment strategy is required to manage the condition. The use of RAS inhibitor therapy for patients with hypertension and albuminuria and all the more as of late the use of SGLT-2is in light of discoveries from cardiovascular outcome trials.
The FIDELIO-DKD study that was conducted examined finerenone in patients with diabetes and kidney disease. The research titled “Finerenone in Predominantly Advanced CKD and Type 2 Diabetes With or Without Sodium-Glucose Cotransporter-2 Inhibitor Therapy” thereby was put forth by Peter Rossing and colleagues published in the Kidney International Reports. The summary has been given below.
Objective:
To investigate the treatment impact of finerenone in patients with accompanying use of SGLT2i at baseline or during the trial.
Method:
A total of 5674 patients having a UACR (30 – 5000 mg/g) and an eGFR of 25-75 ml/min per 1.73 m2 who were on optimized RAS inhibitor therapy were randomized for this trial.
The key endpoints included time to kidney failure, sustained decrease in eGFR > 40% from baseline and renal death and secondary cardiovascular outcomes such as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure.
Findings:
Finerenone improved the reduction of UACR in patients who received SGLT2i. It also conferred renal and cardiovascular benefits regardless of the use of SGLT2i.
Limitations:
There is potential for bias as only a small number of patients in FIDELIO-DKD received an SGLT2i at baseline. Secondly, it is a non-randomized analysis as SGLT-2i subgroups in the trial were defined after completing randomization. There is a chance of confounding result due to known UACR-lowering effects of glucagon-like peptide-1 receptor agonist treatment.
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