2026-04-14T05:51:31Zhttps://recercat.cat/oai/request

oai:recercat.cat:2445/1958062025-11-20T15:55:08Zcom_2072_1057col_2072_478798col_2072_478917col_2072_478921

00925njm 22002777a 4500 dc Bakris, George L. author Agarwal, Rajiv author Anker, Stefan D. author Pitt, Bertram author Ruilope, L. M. author Rossing, Peter author Kolkhof, Peter author Nowack, Christina author Schloemer, Patrick author Joseph, Amer author Filippatos, Gerasimos S. author FIDELIO-DKD Investigators author Cruzado, Josep Ma. author 2023-03-22T19:23:27Z 2023-03-22T19:23:27Z 2020-12-03 2023-03-22T19:23:28Z Background: Finerenone, a nonsteroidal, selective mineralocorticoid receptor antagonist, reduced albuminuria in short-term trials involving patients with chronic kidney disease (CKD) and type 2 diabetes. However, its long-term effects on kidney and cardiovascular outcomes are unknown. Methods: In this double-blind trial, we randomly assigned 5734 patients with CKD and type 2 diabetes in a 1:1 ratio to receive finerenone or placebo. Eligible patients had a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 30 to less than 300, an estimated glomerular filtration rate (eGFR) of 25 to less than 60 ml per minute per 1.73 m2 of body-surface area, and diabetic retinopathy, or they had a urinary albumin-to-creatinine ratio of 300 to 5000 and an eGFR of 25 to less than 75 ml per minute per 1.73 m2. All the patients were treated with renin-angiotensin system blockade that had been adjusted before randomization to the maximum dose on the manufacturer's label that did not cause unacceptable side effects. The primary composite outcome, assessed in a time-to-event analysis, was kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes. The key secondary composite outcome, also assessed in a time-to-event analysis, was death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Results: During a median follow-up of 2.6 years, a primary outcome event occurred in 504 of 2833 patients (17.8%) in the finerenone group and 600 of 2841 patients (21.1%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.93; P = 0.001). A key secondary outcome event occurred in 367 patients (13.0%) and 420 patients (14.8%) in the respective groups (hazard ratio, 0.86; 95% CI, 0.75 to 0.99; P = 0.03). Overall, the frequency of adverse events was similar in the two groups. The incidence of hyperkalemia-related discontinuation of the trial regimen was higher with finerenone than with placebo (2.3% and 0.9%, respectively). Conclusions: In patients with CKD and type 2 diabetes, treatment with finerenone resulted in lower risks of CKD progression and cardiovascular events than placebo. (Funded by Bayer; FIDELIO-DKD ClinicalTrials.gov number, NCT02540993.). Diabetis Insuficiència renal crònica Malalties cròniques Assaigs clínics de medicaments Diabetes Chronic renal failure Chronic diseases Drug testing Effect of Finerenone on chronic kidney disease outcomes in type 2 diabetes