Finerenone is a non-selective mineralocorticoid receptor antagonist medication that has been shown to reduce albuminuria, the condition of high protein in the urine—and an indicator of chronic kidney disease (CKD). Researchers had previously not assessed the treatment’s effects on kidney and cardiovascular outcomes. 

A new study has shown that finerenone resulted in a lower risk of the progression of chronic kidney disease and cardiovascular events in patients with type 2 diabetes (T2D).* 

What they did 

In the new study published in the New England Journal of Medicine, investigators sought out to understand these effects on a specific population over a median period of 2.6 years. Researchers analyzed 5,734 patients with chronic kidney disease and type 2 diabetes, and who met other criteria, such as certain ranges of estimated glomerular filtration rates (eGFR) and albumin-to-creatinine ratios. 

The majority of the participants—70.2%—were male, and the mean age was about 65 years old. Participants received either finerenone or a placebo, in addition to a renin-angiotensin system blockade. 

Common medications used to block the RAAS are ACE inhibitors and ARBs (angiotensin receptor blockers). This has shown to be beneficial in patients with acute myocardial infarction, chronic systolic heart failure, hypertension, stroke, and diabetic renal disease.

What they found

The researchers looked primarily at the impact on kidney health, such as:

• Occurrence of kidney failure
• Large decrease in eGFR
• Death from renal failure

Secondarily, they monitored the impact on cardiovascular health, looking at: 

• Death from cardiovascular causes
• Nonfatal myocardial infarction
• Nonfatal stroke
• Hospitalization

Events related to kidney health occurred in about 18% of patients in the finerenone group versus 21% in the placebo group. Events related to cardiovascular health occurred in 13% of patients treated with finerenone and in about 15% of placebo-treated patients.  

The overall frequency of adverse effects in each group was similar, with about 32% of patients in the finerenone group compared with about 34% of those in the placebo group.

The investigators explain that the benefits of finerenone were observed after 12 months for the kidney outcome and as early as one month for the cardiovascular outcome, and benefits persisted through the trial.

What it means

While the study provides some promising results, it’s important to note the limitations of the study, which include:

• Hyperkalemia-related adverse events had a two-fold higher incidence with finerenone than with placebo (18.3% and 9%, respectively). Hyperkalemia is the presence of high amounts of potassium in the blood, which can lead to heart conditions.
• Only 4.7% of the study population was Black, limiting the ability to generalize the findings.
• Participants with CKD caused by T2D were included, whereas people with CKD not caused by T2D were excluded.

Despite promising initial results, further studies should be pursued to better understand the impacts of the finerenone treatment on different populations with CKD in its potential to improve renal and cardiovascular health.

*Alicea, J. (2020, Oct. 25). Finerenone Linked to Reduced Cardiorenal Events for Chronic Kidney Disease. HCPLive. https://www.hcplive.com/view/finerenone-reduced-cardiorenal-events-chronic-kidney-disease