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Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes

Chronic kidney disease is frequently associated with hypertension and poorly controlled blood pressure can lead to chronic kidney disease progression. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly improves cardiorenal outcomes in patients with chronic kidney disease...

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Autores principales: Ruilope, Luis M., Agarwal, Rajiv, Anker, Stefan D., Filippatos, Gerasimos, Pitt, Bertram, Rossing, Peter, Sarafidis, Pantelis, Schmieder, Roland E., Joseph, Amer, Rethemeier, Nicole, Nowack, Christina, Bakris, George L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640256/
https://www.ncbi.nlm.nih.gov/pubmed/36252131
http://dx.doi.org/10.1161/HYPERTENSIONAHA.122.19744
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author Ruilope, Luis M.
Agarwal, Rajiv
Anker, Stefan D.
Filippatos, Gerasimos
Pitt, Bertram
Rossing, Peter
Sarafidis, Pantelis
Schmieder, Roland E.
Joseph, Amer
Rethemeier, Nicole
Nowack, Christina
Bakris, George L.
author_facet Ruilope, Luis M.
Agarwal, Rajiv
Anker, Stefan D.
Filippatos, Gerasimos
Pitt, Bertram
Rossing, Peter
Sarafidis, Pantelis
Schmieder, Roland E.
Joseph, Amer
Rethemeier, Nicole
Nowack, Christina
Bakris, George L.
author_sort Ruilope, Luis M.
collection PubMed
description Chronic kidney disease is frequently associated with hypertension and poorly controlled blood pressure can lead to chronic kidney disease progression. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly improves cardiorenal outcomes in patients with chronic kidney disease and type 2 diabetes. This analysis explored the relationship between office systolic blood pressure (SBP) and cardiorenal outcomes with finerenone in FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease). METHODS: Patients with type 2 diabetes, urine albumin-to-creatinine ratio 30 to 5000 mg/g, and estimated glomerular filtration rate of 25 to <75 mL/min per 1.73 m(2) receiving optimized renin-angiotensin system blockade, were randomized to finerenone or placebo. For this analysis, patients (N=5669) were grouped by baseline office SBP quartiles. RESULTS: Finerenone reduced office SBP across the baseline office SBP quartiles, including patients with baseline office SBP of >148 mm Hg. Overall, patients with lower baseline office SBP quartile and greater declines from baseline in SBP were associated with better cardiorenal outcomes. The risk of primary kidney and key secondary cardiovascular composite outcomes was consistently reduced with finerenone versus placebo irrespective of baseline office SBP quartiles (P for interaction 0.87 and 0.78, respectively). A time-varying analysis revealed that 13.8% and 12.6% of the treatment effect with finerenone was attributed to the change in office SBP for the primary kidney composite outcome and the key secondary cardiovascular outcome, respectively. CONCLUSIONS: In FIDELIO-DKD, cardiorenal outcomes improved with finerenone irrespective of baseline office SBP. Reductions in office SBP accounted for a small proportion of the treatment effect on cardiorenal outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02540993.
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spelling pubmed-96402562022-11-14 Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes Ruilope, Luis M. Agarwal, Rajiv Anker, Stefan D. Filippatos, Gerasimos Pitt, Bertram Rossing, Peter Sarafidis, Pantelis Schmieder, Roland E. Joseph, Amer Rethemeier, Nicole Nowack, Christina Bakris, George L. Hypertension Original Articles Chronic kidney disease is frequently associated with hypertension and poorly controlled blood pressure can lead to chronic kidney disease progression. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly improves cardiorenal outcomes in patients with chronic kidney disease and type 2 diabetes. This analysis explored the relationship between office systolic blood pressure (SBP) and cardiorenal outcomes with finerenone in FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease). METHODS: Patients with type 2 diabetes, urine albumin-to-creatinine ratio 30 to 5000 mg/g, and estimated glomerular filtration rate of 25 to <75 mL/min per 1.73 m(2) receiving optimized renin-angiotensin system blockade, were randomized to finerenone or placebo. For this analysis, patients (N=5669) were grouped by baseline office SBP quartiles. RESULTS: Finerenone reduced office SBP across the baseline office SBP quartiles, including patients with baseline office SBP of >148 mm Hg. Overall, patients with lower baseline office SBP quartile and greater declines from baseline in SBP were associated with better cardiorenal outcomes. The risk of primary kidney and key secondary cardiovascular composite outcomes was consistently reduced with finerenone versus placebo irrespective of baseline office SBP quartiles (P for interaction 0.87 and 0.78, respectively). A time-varying analysis revealed that 13.8% and 12.6% of the treatment effect with finerenone was attributed to the change in office SBP for the primary kidney composite outcome and the key secondary cardiovascular outcome, respectively. CONCLUSIONS: In FIDELIO-DKD, cardiorenal outcomes improved with finerenone irrespective of baseline office SBP. Reductions in office SBP accounted for a small proportion of the treatment effect on cardiorenal outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02540993. Lippincott Williams & Wilkins 2022-10-12 2022-12 /pmc/articles/PMC9640256/ /pubmed/36252131 http://dx.doi.org/10.1161/HYPERTENSIONAHA.122.19744 Text en © 2022 The Authors. https://creativecommons.org/licenses/by-nc-nd/4.0/Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle Original Articles
Ruilope, Luis M.
Agarwal, Rajiv
Anker, Stefan D.
Filippatos, Gerasimos
Pitt, Bertram
Rossing, Peter
Sarafidis, Pantelis
Schmieder, Roland E.
Joseph, Amer
Rethemeier, Nicole
Nowack, Christina
Bakris, George L.
Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
title Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
title_full Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
title_fullStr Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
title_full_unstemmed Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
title_short Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
title_sort blood pressure and cardiorenal outcomes with finerenone in chronic kidney disease in type 2 diabetes
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640256/
https://www.ncbi.nlm.nih.gov/pubmed/36252131
http://dx.doi.org/10.1161/HYPERTENSIONAHA.122.19744
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