Title : Revolutionizing CKD care: How finerenone transforms outcomes in heart and kidney health – insights from fidelio-DKD
Abstract:
Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA) designed to manage heart failure, especially in patients with chronic kidney disease (CKD) and type 2 diabetes. Heart failure and CKD frequently co-exist, and the combination poses a particularly high cardiovascular risk. Finerenone stands out from traditional MRAs due to its targeted mechanism of action, which minimizes fibrosis and inflammation in both the heart and kidneys, two critical drivers of disease progression. In contrast to steroidal MRAs, finerenone’s non-steroidal structure allows for a more selective binding to mineralocorticoid receptors, reducing the likelihood of common MRA-associated side effects, especially hyperkalemia, or high potassium levels, a condition that can severely limit the use of traditional MRAs in patients with CKD.
The efficacy and safety profile of finerenone have been validated in two major studies: FIDELIO-DKD and FIGARO-DKD. The FIDELIO-DKD trial included over 5,700 patients with CKD and type 2 diabetes, revealing that finerenone significantly reduced the risk of kidney disease progression and cardiovascular events. Specifically, patients treated with finerenone experienced a 31% lower risk of experiencing a decline in kidney function (defined by a 40% reduction in estimated glomerular filtration rate), kidney failure, or death due to renal causes compared to those on a placebo. Moreover, cardiovascular event rates, including heart failure hospitalizations and deaths related to cardiovascular issues, were reduced by approximately 18% in the finerenone group.
FIGARO-DKD, involving nearly 7,500 patients, also demonstrated that finerenone was effective in reducing cardiovascular outcomes by around 13% compared to placebo. The trial particularly highlighted the drug's effect on reducing heart failure hospitalization, a key concern in patients with CKD and type 2 diabetes. Importantly, both trials reported that finerenone’s safety profile was favorable, showing lower incidences of hyperkalemia compared to traditional MRAs, thus making it a safer choice for CKD patients at risk of potassium retention issues.
With these results, finerenone offers a promising therapeutic option, not only for slowing CKD progression but also for managing cardiovascular risks in patients with type 2 diabetes and CKD. Its dual role in reducing both kidney and cardiovascular complications positions it as an essential part of the therapeutic landscape for high-risk heart failure patients.
