Finerenone in Persons with Chronic Kidney Disease without Diabetes

作者：Hiddo J.L. Heerspink, Brendon L. Neuen, Rajiv Agarwal, D Cherney, C S P Lam, K R Tuttle, Christoph Wanner, Pantelis Sarafidis, Niels Jongs, J David Smeijer, Meike Brinker, Nicole Rethemeier, Patrick Schloemer, Paula Vesterinen, David Goldsbury, Sara Dizayee, Jon W. Mares, V Perkovic · 发表于：New England Journal of Medicine · 年份：2026 · DOI：10.1056/nejmoa2604625 · 被引用次数：9 · 研究领域：Hormonal Regulation and Hypertension、Adrenal Hormones and Disorders、Heart Failure Treatment and Management

BACKGROUND: In randomized trials, finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improved kidney and cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease (CKD). Whether finerenone has similar effects in patients without diabetes who have CKD is unknown. METHODS: of body-surface area) and albuminuria (urinary albumin-to-creatinine ratio, 200 to ≤3500, with albumin in milligrams and creatinine in grams) and were using a renin-angiotensin system inhibitor to receive finerenone (10 or 20 mg daily) or placebo. The primary outcome was the total eGFR slope (mean annual rate of change in the eGFR from baseline to month 32), assessed with a two-slope linear spline mixed-effects model. Secondary outcomes included a composite of kidney or cardiovascular events (reduction from baseline of at least 57% in the eGFR, kidney failure, hospitalization for heart failure, or death from cardiovascular causes), a composite of the two kidney events, and a composite of the two cardiovascular events. RESULTS: (95% CI, -4.3 to -3.8) with placebo (difference, 0.7; 95% CI, 0.3 to 1.1; P<0.001). Prespecified hierarchical testing showed that the risk of a composite kidney or cardiovascular outcome event was lower with finerenone than with placebo (hazard ratio, 0.77; 95% CI, 0.60 to 0.99; P = 0.04); the hazard ratio was 0.78 (95% CI, 0.60 to 1.01) for the composite of the two kidney events and 0.60 (95% CI, 0.27 to 1.33) for the composite of the two cardio...