Effects of finerenone in people with chronic kidney disease and type 2 diabetes are independent of HbA1c at baseline, HbA1c variability, diabetes duration and insulin use at baseline
Authors' conclusion
Finerenone efficacy was not modified by baseline HbA1c, HbA1c variability, diabetes duration or baseline insulin use. Greater HbA1c variability appeared to be associated with an increased risk of cardiorenal outcomes.
Study context
- Population
- People with CKD and T2D
- Participants
- 13,026 people
- Comparison
- Finerenone vs placebo, by baseline HbA1c, HbA1c variability, diabetes duration and baseline insulin use
- Primary endpoint
- CV composite (CV death, non-fatal MI, non-fatal stroke or hospitalization for HF) and kidney composite (kidney failure, sustained ≥ 57% eGFR decline or renal death)
Primary result
As reported in the abstract
CV and kidney composite outcomes, finerenone vs placebo, by subgroup
- Risk reductions in CV and kidney composite outcomes with finerenone vs placebo were consistent across HbA1c quartiles, HbA1c variability, diabetes duration and insulin use
- Finerenone vs Placebo: P interaction .52 and .09
- Finerenone vs Placebo: P interaction .48 and .10
- Finerenone vs Placebo: P interaction .12 and .75
- Finerenone vs Placebo: P interaction .16 and .52
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Diabetes progression (new insulin initiation, increase in antidiabetic medication, 1.0% HbA1c increase, new DKA or uncontrolled diabetes)No effect | 1.00 (0.95–1.04) | |
| 0.512Hazard ratio (log scale) |
HbA1c variability in first year of treatment and CV events
- HR, higher HbA1c variability
- 1.20 (95% CI 1.07-1.35; P = .0016)
HbA1c variability in first year of treatment and kidney events
- HR, higher HbA1c variability
- 1.36 (95% CI 1.21-1.52; P < .0001)
Safety
Tolerability and hyperkalaemia
- Finerenone was well-tolerated across subgroups; discontinuation and hospitalization because of hyperkalaemia were low
Original publication
Effects of finerenone in people with chronic kidney disease and type 2 diabetes are independent of HbA1c at baseline, HbA1c variability, diabetes duration and insulin use at baseline. Diabetes Obes Metab. Published 26 February 2023. doi:10.
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