Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
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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.; the FIDELIO-DKD Investigators.
In: Hypertension, Vol. 79, No. 12, 2022, p. 2685-2695.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes
AU - Ruilope, Luis M.
AU - Agarwal, Rajiv
AU - Anker, Stefan D.
AU - Filippatos, Gerasimos
AU - Pitt, Bertram
AU - Rossing, Peter
AU - Sarafidis, Pantelis
AU - Schmieder, Roland E.
AU - Joseph, Amer
AU - Rethemeier, Nicole
AU - Nowack, Christina
AU - Bakris, George L.
AU - the FIDELIO-DKD Investigators
N1 - Publisher Copyright: © 2021 American Heart Association, Inc.
PY - 2022
Y1 - 2022
N2 - Background: 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 m2 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.
AB - Background: 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 m2 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.
KW - blood pressure
KW - chronic kidney diseases
KW - finerenone
KW - mineralocorticoid receptor antagonist
KW - systolic blood pressure
KW - type 2 diabetes
U2 - 10.1161/HYPERTENSIONAHA.122.19744
DO - 10.1161/HYPERTENSIONAHA.122.19744
M3 - Journal article
C2 - 36252131
AN - SCOPUS:85141891695
VL - 79
SP - 2685
EP - 2695
JO - Hypertension
JF - Hypertension
SN - 0194-911X
IS - 12
ER -
ID: 329293561