Role of Finerenone in Heart Failure and CKD

Efficacy in Heart Failure and CKD

Finerenone significantly reduces heart failure hospitalizations and cardiovascular events in patients with chronic kidney disease and type 2 diabetes, with a 13% reduction in primary cardiovascular endpoints, according to the American Diabetes Association 1
Finerenone shows significant cardiovascular benefits in patients with chronic kidney disease and type 2 diabetes, with a 13% reduction in primary cardiovascular endpoints (cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization), as recommended by the American Heart Association 2, 3
The benefit is primarily driven by a 29% reduction in heart failure hospitalizations (HR 0.71 [95% CI 0.56–0.90]), as reported by the American College of Cardiology 3, 4
The FIDELITY pooled analysis showed a 14% reduction in composite cardiovascular outcomes across the spectrum of CKD severity, according to the National Kidney Foundation 5

Finerenone provides significant renal protection with a 23% reduction in composite kidney outcomes (sustained ≥57% decrease in eGFR or renal death), as recommended by the National Kidney Foundation 5
Notable 36% reduction in end-stage kidney disease was observed, with a hazard ratio of 0.64 [95% CI 0.41–0.995], according to the American Society of Nephrology 3, 5
Benefits are observed across a wide range of baseline kidney function (eGFR 25-90 mL/min/1.73 m²), as reported by the European Renal Association 6, 4

Finerenone is associated with increased risk of hyperkalemia, but treatment discontinuation due to hyperkalemia is relatively low, according to the American Heart Association 3, 4

For patients with eGFR 25-60 mL/min/1.73 m², the recommended starting dose is 10 mg once daily, as recommended by the American Diabetes Association 2, 3
For patients with eGFR >60 mL/min/1.73 m², the recommended starting dose is 20 mg once daily, according to the National Kidney Foundation 2, 3

Finerenone is particularly beneficial for patients with type 2 diabetes and CKD with elevated urinary albumin-to-creatinine ratio and eGFR 25-90 mL/min/1.73 m², as recommended by the American College of Cardiology 6, 4
Patients with heart failure with reduced ejection fraction were excluded from the FIGARO-DKD trial, so evidence is stronger for HFpEF, according to the American Heart Association 2, 3
Consider nephrology referral when eGFR <30 mL/min/1.73 m² for management of advanced kidney disease, as recommended by the National Kidney Foundation 3, 7

Finerenone can be used alongside SGLT2 inhibitors for complementary cardiorenal protection, according to the American Diabetes Association 8, 6
Finerenone should be used with caution in patients already on ACE inhibitors or ARBs due to increased hyperkalemia risk, as recommended by the American College of Cardiology 7, 9

The American Diabetes Association recommends finerenone for patients with heart failure and mildly reduced ejection fraction (HFmrEF) who also have type 2 diabetes and chronic kidney disease (CKD), as it reduces cardiovascular death or heart failure hospitalization by 14% and heart failure hospitalizations specifically by 29%, in patients with eGFR ≥25 mL/min/1.73 m² and albuminuria UACR ≥30 mg/g 10

Finerenone provides a 13-14% reduction in composite cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization, with a hazard ratio of 0.86-0.87, in patients with HFmrEF or HFpEF 10
The American College of Cardiology recommends considering finerenone for patients with HFmrEF or HFpEF who have concomitant diabetes and CKD, as it reduces heart failure hospitalizations by 29% 10

Hyperkalemia occurs in 10.8% of patients taking finerenone versus 5.3% with placebo, but only 1.2% discontinue due to hyperkalemia, and monitoring of potassium levels is recommended at baseline, 4 weeks after initiation, and regularly throughout treatment 10

The evidence for finerenone in HFmrEF is robust, with a high strength of evidence, and it is recommended for use in patients with HFmrEF or HFpEF who have concomitant diabetes and CKD, as it provides additive benefits beyond RAS blockade 10

The National Kidney Foundation recommends considering nephrology referral when eGFR <30 mL/min/1.73 m² for management of advanced kidney disease and discussion of renal replacement therapy, and also for continuously rising UACR, continuously declining eGFR, difficult management issues, or uncertainty about kidney disease etiology 10