Risk of Hyperkalemia With Empagliflozin, Finerenone, or Both

作者：Rajiv Agarwal, Jennifer B. Green, Hiddo J.L. Heerspink, Janet B. McGill, Amy K. Mottl, Masaomi Nangaku, Julio Rosenstock, Peter Rossing, Muthiah Vaduganathan, Carolina Solis‐Herrera, Charlie Scott, Li Li, Meike Brinke, Carolina Aldworth, Johannes F.E. Mann · 发表于：Journal of the American College of Cardiology · 年份：2025 · DOI：10.1016/j.jacc.2025.10.049 · 被引用次数：6 · 研究领域：Potassium and Related Disorders、Diabetes Treatment and Management、Parathyroid Disorders and Treatments

BACKGROUND: Hyperkalemia is common with renin-angiotensin system inhibitor (RASi) therapy, frequently leading to treatment interruption and potentially curtailing cardiovascular and kidney benefits. Sodium-glucose cotransporter 2 inhibitors might mitigate the risk of hyperkalemia with RASis. OBJECTIVES: This prespecified secondary analysis of the CONFIDENCE trial aimed to investigate the impact of empagliflozin, finerenone (a nonsteroidal mineralocorticoid receptor antagonist), and their combination on hyperkalemia, and whether hyperkalemia mediates albuminuria reduction in high-risk patients with chronic kidney disease and type 2 diabetes with albuminuria. METHODS: ), and albuminuria (urine albumin-to-creatinine ratio [UACR]: 100-5,000 mg/g) on stable doses of RASis were randomized 1:1:1 to empagliflozin, finerenone, or both. The primary outcome was change in UACR from baseline to Day 180. Mean changes in potassium were estimated using linear mixed models. Logistic regression models assessed the risk of moderate (serum potassium >5.5 mmol/L) and severe (serum potassium >6.0 mmol/L) hyperkalemia. Causal mediation analysis was used to ascertain the impact of hyperkalemia on mean UACR change at Day 180. RESULTS: Patients developing hyperkalemia had lower estimated glomerular filtration rate, higher potassium, and more severe albuminuria at baseline. Hyperkalemia events accumulated over the 180 days of the trial in all 3 groups. There were few treatment discontinuations. Randomi...