Cardiometabolic & kidneyMeta-analysis
Modifiability of Composite Cardiovascular Risk Associated With Chronic Kidney Disease in Type 2 Diabetes With Finerenone
- Secondary analysis of the FIDELITY pooled analysis of randomised trials
- pooled analysis of 2 phase 3 trials
- population-level simulation with NHANES data
Authors' conclusion
Results of this subanalysis of the FIDELITY analysis suggest that CKD-associated composite cardiovascular risk may be modifiable with finerenone treatment in patients with T2D, those with eGFR of 25 or higher, and those with UACR of 30 mg/g or greater.
Study context
- Population
- Patients with T2D and chronic kidney disease (CKD)
- Participants
- 13,026 patients
- Comparison
- Finerenone vs placebo
- Outcome
- Composite CV events (CV death, nonfatal stroke, nonfatal MI or hospitalization for HF), by eGFR and albuminuria categories
- Follow-up
- Median 3.0 years
Pooled result
Composite CV events
Hazard ratio
0.86
95% CI 0.78–0.95
P = 0.002
Finerenone vs Placebo
HR 0.86 (95% CI 0.78–0.95); P = 0.002
As reported in the abstract
Further pooled results
CV events incidence, Placebo, eGFR ≥90, by UACR · median 3.0 years
- CV events incidence, Placebo, estimated glomerular filtration rate (eGFR) ≥90, by urine albumin to creatinine ratio (UACR): Lower eGFR and higher albuminuria associated with higher CV event incidence
CV events incidence, Placebo, eGFR <30, by UACR · median 3.0 years
- Placebo, eGFR <30, UACR <300 mg/g: incidence per 100 patient-years
- 6.54 (95% CI 4.19-9.40)
- Placebo, eGFR <30, UACR ≥300 mg/g: incidence per 100 patient-years
- 8.74 (95% CI 6.78-10.93)
Simulated CV events prevented by 1 year of finerenone (population level)
- Treatment-eligible individuals
- 6.4 million (95% CI 5.4-7.4 million)
- CV events prevented
- 38 359 (95% CI 31 741-44 852)
- HF hospitalizations prevented
- approximately 14 000
- Prevented in eGFR ≥60 (25 357 of 38 360)
- 66%
- simulation with NHANES data
Original publication
Modifiability of Composite Cardiovascular Risk Associated With Chronic Kidney Disease in Type 2 Diabetes With Finerenone. JAMA Cardiol. Published 1 August 2023. doi:10.1001/jamacardio.2023.1505
Summarised from the published abstract; every number is checked against it