Finerenone Efficacy in Patients with Chronic Kidney Disease, Type 2 Diabetes, and Anemia in FIDELITY

作者：A.K. Singh, Glen James, Stefan D. Anker, Bertram Pitt, Peter Rossing, Luís M. Ruilope, Alfredo E. Farjat, Youssef M.K. Farag, Luke Roberts, Gerasimos Filippatos · 发表于：JACC Advances · 年份：2025 · DOI：10.1016/j.jacadv.2024.101524 · 被引用次数：3 · 研究领域：Erythropoietin and Anemia Treatment、Dialysis and Renal Disease Management、Potassium and Related Disorders

BACKGROUND: Anemia is common in patients with chronic kidney disease and type 2 diabetes. Finerenone improved heart and kidney outcomes in patients with chronic kidney disease and type 2 diabetes in FIDELITY. OBJECTIVES: This post hoc analysis investigated the efficacy and safety of finerenone vs placebo by baseline anemia status. METHODS: Anemia was defined as serum hemoglobin levels <13 g/dL (male) or <12 g/dL (female) or treatment with an erythropoiesis-stimulating agent at baseline. Outcomes included cardiovascular (CV) and kidney composites, hospitalization for heart failure, and all-cause mortality. Safety was assessed through treatment-emergent adverse events. RESULTS: Of 12,971 patients, 33% had anemia at baseline. Finerenone reduced the risk of the CV composite outcome to a greater extent in patients with vs without anemia (HR: 0.75 [95% CI: 0.65-0.88] vs HR: 0.93 [95% CI: 0.82-1.05]; P for interaction = 0.03). Finerenone reduced the risk of the kidney composite outcome vs placebo, with no heterogeneity between patients with vs without anemia (HR: 0.79 [95% CI: 0.65-0.95] and HR: 0.74 [95% CI: 0.60-0.91]; P for interaction = 0.77). The risk of hospitalization for heart failure and all-cause mortality was lower with finerenone vs placebo, irrespective of anemia status. Patients with anemia experienced higher incidence of treatment-emergent hyperkalemia vs those without. CONCLUSIONS: Finerenone demonstrated CV and kidney benefit in patients with and without anemia. The...