Simultaneous initiation of finerenone and empagliflozin across the spectrum of kidney risk in the CONFIDENCE trial

作者：Muthiah Vaduganathan, Jennifer B. Green, Hiddo J.L. Heerspink, Sung Gyun Kim, Johannes F.E. Mann, Janet B. McGill, Amy K. Mottl, Masaomi Nangaku, Julio Rosenstock, Peter Rossing, Li Li, Na Li, Katja Rohwedder, Charlie Scott, Rajiv Agarwal · 发表于：Nephrology Dialysis Transplantation · 年份：2025 · DOI：10.1093/ndt/gfaf160 · 被引用次数：6 · 研究领域：Diabetes Treatment and Management、Parathyroid Disorders and Treatments、Dialysis and Renal Disease Management

BACKGROUND: The CONFIDENCE (COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with CKD and type 2 diabetes using a UACR Endpoint) trial investigated the safety and efficacy of simultaneously initiating finerenone and empagliflozin for patients with chronic kidney disease (CKD) and type 2 diabetes. This prespecified analysis aimed to determine if the predicted risk of kidney disease progression, based on KDIGO risk categories, influenced the benefits and safety of this combination therapy. METHODS: The double-blind, double-dummy trial randomized 818 adults with CKD and type 2 diabetes [urine albumin-creatinine ratio (UACR) ≥100 to <5000 mg/g] to receive once-daily finerenone plus empagliflozin, finerenone alone or empagliflozin alone, all in addition to a renin-angiotensin system inhibitor. The relative change in UACR from baseline to day 180 (primary endpoint) and a >30% reduction in UACR (secondary endpoint) across KDIGO risk categories was assessed. RESULTS: At baseline, among 781 with available data, 11.3% of participants were classified as low/moderate risk, 29.6% as high risk and 59.2% as very high risk. At 180 days, combination therapy significantly reduced UACR levels across all KDIGO risk categories (low/moderate: -61.7%; high: -60.7%; very high: -52.4%). This reduction was consistently greater than that achieved with either monotherapy alone. More than half of patients on combination therapy experienced UACR reductions of >30% (low/moderate: 58.1%; h...