Finerenone and Kidney Outcomes in Patients With Heart Failure: The FINEARTS-HF Trial.
In the FINEARTS-HF trial of patients with heart failure with mildly reduced or preserved ejection fraction, finerenone did not significantly change the composite kidney outcome but produced early and sustained reductions in albuminuria.
Background
Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has kidney-protective effects in patients with chronic kidney disease and type 2 diabetes, but its effects on kidney outcomes in patients with heart failure, with or without diabetes or chronic kidney disease, were not established. FINEARTS-HF was a randomized trial of finerenone versus placebo in patients with heart failure with mildly reduced or preserved ejection fraction.
Study design
This prespecified analysis examined kidney outcomes among 6,001 participants (mean baseline estimated glomerular filtration rate 62 ml/min/1.73 m2; 48% with values below 60). Outcomes included a composite of sustained 50% or greater estimated glomerular filtration rate decline or kidney failure, a 57% or greater decline composite, estimated glomerular filtration rate slope, and changes in urine albumin-to-creatinine ratio over a median follow-up of 2.6 years.
Key findings
The composite kidney outcome (50% or greater estimated glomerular filtration rate decline or kidney failure) was numerically but nonsignificantly higher with finerenone than placebo (75 vs 55 events; HR 1.33; 95% CI 0.94-1.89), in a population at low risk of adverse kidney outcomes. Finerenone caused an acute initial estimated glomerular filtration rate decline of -2.9 ml/min/1.73 m2 over the first 3 months but did not alter the chronic slope thereafter. It reduced urine albumin-to-creatinine ratio by 30% over 6 months and lowered the risk of new-onset microalbuminuria by 24% and macroalbuminuria by 38%.
Clinical implications
In this lower-kidney-risk heart failure population, finerenone did not significantly modify hard kidney composite endpoints, but its early and durable albuminuria reduction is consistent with the antiproteinuric effects seen in diabetic kidney disease trials. The acute estimated glomerular filtration rate dip without a worse chronic slope reflects an expected hemodynamic effect rather than progressive injury.
Category
Research
Source
J Am Coll Cardiol
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