Cardiometabolic & kidneyMeta-analysis
Finerenone Across Cardiovascular-Kidney-Metabolic Syndrome Stages
- Post hoc pooled analysis of 2 randomised controlled trials (FIDELITY)
- double-blind
- placebo-controlled
- phase 3
- multinational
- multicentre
- 48 countries
Authors' conclusion
Among patients with T2D and CKD in this study, finerenone reduced risks of cardiovascular and kidney events across CKM stages and led to greater CKM syndrome regression, and lesser CKM syndrome progression, over time.
Study context
- Population
- Patients with T2D and chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) ≥25 mL/min/1.73 m², serum potassium ≤4.8 mmol/L, on maximally tolerated renin angiotensin system inhibitor), classified into cardiovascular-kidney-metabolic (CKM) syndrome stages by AHA criteriastage 2 3864, stage 3 3275, stage 4 5851
- Participants
- 12,990 patients
- Comparison
- Finerenone vs placebo across CKM syndrome stages
- Outcome
- CV composite (CV death, nonfatal MI, nonfatal stroke or HF hospitalization) and kidney composite (kidney failure, sustained ≥57% eGFR decrease from baseline over ≥4 weeks, or death from kidney failure), by CKM stage
- Follow-up
- Median 3 years
Pooled result
As reported in the abstract
CV composite and kidney composite, by baseline CKM stage
Finerenone consistently reduced CV events, irrespective of baseline CKM stage
P for interaction = .86
Finerenone consistently reduced kidney events, irrespective of baseline CKM stage
P for interaction = .65
Absolute rate reduction, CV composite, stage 4
−1.1 per 100 person-years
Absolute rate reduction, CV composite, stage 2
−0.4 per 100 person-years
Further pooled results
| Outcome | Finerenone | Placebo | Estimate | P value | |
|---|---|---|---|---|---|
| CV and kidney events, CKM stage 4 vs stage 2 (prognosis) · median follow-up 3 years — Stage 4 vs Stage 2 · CV events | aHR 1.87 (95% CI 1.56–2.24) | ||||
| CV and kidney events, CKM stage 4 vs stage 2 (prognosis) · median follow-up 3 years — Stage 4 vs Stage 2 · kidney events | aHR 1.96 (95% CI 1.43–2.69) | ||||
| CKM syndrome regression · median 3 years | 11.4% | 7.4% | aOR 1.66 (95% CI 1.30–2.13) | P < 0.001 | |
| CKM syndrome progression · median 3 years | aOR 0.89 (95% CI 0.79–1.00) | P = 0.05 | |||
| 0.20.5125Ratio (log scale) |
Original publication
Finerenone Across Cardiovascular-Kidney-Metabolic Syndrome Stages. JAMA Cardiol. Published 1 July 2026. doi:10.1001/jamacardio.2026.1365
Summarised from the published abstract; every number is checked against it