Finerenone and Kidney Outcomes in Patients With Heart Failure

作者：Finnian R. Mc Causland, Muthiah Vaduganathan, Brian Claggett, Ian J. Kulac, Akshay S. Desai, Pardeep S. Jhund, Alasdair D Henderson, Meike Brinker, Robert Perkins, Markus F. Scheerer, Patrick Schloemer, Carolyn S.P. Lam, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Faı̈ez Zannad, Bertram Pitt, John J.V. McMurray, Scott D. Solomon · 发表于：Journal of the American College of Cardiology · 年份：2024 · DOI：10.1016/j.jacc.2024.10.091 · 被引用次数：75 · 研究领域：Heart Failure Treatment and Management、Pulmonary Hypertension Research and Treatments、Dialysis and Renal Disease Management

BACKGROUND: Finerenone has kidney-protective effects in patients with chronic kidney disease with type 2 diabetes, but effects on kidney outcomes in patients with heart failure with and without diabetes and/or chronic kidney disease are not known. OBJECTIVES: The purpose of this study was to examine the effects of finerenone on kidney outcomes in FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure), a randomized trial of finerenone vs placebo among patients with heart failure with mildly reduced or preserved ejection fraction. METHODS: ; initiation of maintenance dialysis; renal transplantation). In this prespecified analysis, we also report effects of finerenone on: 1) sustained ≥57% eGFR decline or kidney failure; 2) eGFR slope; and 3) changes in urine albumin/creatinine ratio (UACR). RESULTS: per year.). Finerenone reduced UACR by 30% (95% CI: 25%-34%) over 6 months vs placebo, an effect that persisted throughout follow-up. Finerenone reduced the risk of new-onset of microalbuminuria and macroalbuminuria by 24% (HR: 0.76; 95% CI: 0.68-0.83) and 38% (HR: 0.62; 95% CI: 0.53-0.73), respectively. CONCLUSIONS: In FINEARTS-HF, a population at low risk of adverse kidney outcomes, finerenone did not significantly modify the kidney composite outcomes. Finerenone led to a greater reduction in initial eGFR, but did not result in a significant difference in chronic eGFR slope vs placebo. Finerenone led to early and sustai...