Finerenone Reduces Onset of Atrial Fibrillation in Patients with Chronic Kidney Disease and Type 2 Diabetes
Due to cardiac remodeling and kidney complications, atrial fibrillation or flutter (AFF) risk is high in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). Finerenone is a novel, selective, nonsteroidal mineralocorticoid receptor antagonist. In preclinical models, finerenone has shown to inhibit cardiac remodeling. Gerasimos Filippatos and colleagues have conducted a study under the title “Finerenone Reduces Onset of Atrial Fibrillation in Patients with Chronic Kidney” published in the Journal of the American College of Cardiology. The summary of this paper is given below:
Objective:
To examine the effect of finerenone on new-onset AFF in CKD and T2D patients through secondary analysis of the FIDELIO-DKD trial.
Method:
Patients with CKD and T2D were randomly assigned in 1:1 to receive finerenone or placebo. Inclusion criteria required patients with urine albumin-to-creatinine ratio of ≥30 – ≤5,000 mg/g, an estimated glomerular filtration rate (eGFR) of ≥25 – <75 ml/min/1.73 m2 and they must have received optimized doses of renin-angiotensin system blockade. Effect on new-onset AFF was assessed as a prespecified outcome determined by an independent cardiologist committee. The primary composite outcome includes a sustained ≥40% decrease in eGFR from baseline, kidney failure, or renal death. Secondary outcome considered was nonfatal myocardial infarction, nonfatal stroke, cardiovascular death, or hospitalization for heart failure. This was analyzed by the history of AFF.
Findings:
The study found that finerenone has a sustained effect in lowering the incidence of new-onset AFF in patients with CKD and T2D. As per preclinical data, finerenone was found to demonstrate inhibitory activity against the development of cardiac fibrosis and remodeling caused by mineralocorticoid receptors. Therapies that have kidney-protective and cardioprotective properties can prevent and may result in the prevention of downstream conditions and the improvement of overall outcomes in high-risk patients. Finerenone can be administered as one of the preventive therapy.
Limitation:
Investigators acknowledge that there is a possibility that clinically silent or asymptomatic cases of new-onset AFF might have been missed as the history of AFF was recorded by investigators only at the initiation of the trial and 12-lead ECGs were only conducted annually after the start of the trial unless there was a clinical need. The findings from the trial must be interpreted with caution due to the low number of new onsets AFF events.
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