Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease

Trial Design and Population

The American Diabetes Association recommends that patients with type 2 diabetes and chronic kidney disease (CKD) be considered for finerenone treatment, as demonstrated by the FIGARO-DKD trial, which randomized 7,437 patients to receive either finerenone or placebo 1, 2
Patients with urinary albumin-to-creatinine ratio (UACR) 30 to <300 mg/g and estimated glomerular filtration rate (eGFR) 25-90 mL/min/1.73 m², or UACR 300-5,000 mg/g and eGFR ≥60 mL/min/1.73 m² were eligible for the trial 1, 2, 4
The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines support the use of renin-angiotensin system inhibitors in patients with CKD, and the FIGARO-DKD trial required all participants to be on maximum-tolerated doses of these inhibitors 3

The American College of Cardiology recommends considering finerenone for patients with type 2 diabetes and CKD, as it achieved a 13% relative risk reduction in the primary composite cardiovascular endpoint, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure 1, 2
Finerenone significantly reduced heart failure hospitalizations by 29%, with a hazard ratio of 0.71 [95% CI 0.56-0.90] [1, 2]

The National Kidney Foundation recommends considering finerenone for patients with type 2 diabetes and CKD, as it reduced the risk of end-stage kidney disease by 36%, with a hazard ratio of 0.64 [95% CI 0.41-0.995] [1, 2]

The European Society of Cardiology recommends monitoring patients with type 2 diabetes and CKD for hyperkalemia when treated with finerenone, as it increased the risk of hyperkalemia, with an incidence of 10.8% vs. 5.3% in placebo 1, 2
However, only 1.2% of patients on finerenone discontinued due to hyperkalemia, and no deaths related to hyperkalemia occurred during the trial 1, 2, 5, 6