Effectiveness of Finerenone in Slowing Chronic Kidney Disease Progression After Hospitalization for Heart Failure: A FIDELITY Subgroup Analysis.

BACKGROUND: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces risk of heart and kidney outcomes in people with chronic kidney disease (CKD) and type 2 diabetes (T2D). Heart failure is the leading cause of hospitalization in patients with CKD. Here we evaluated whether the reduction in estimated glomerular filtration rate (eGFR) decline (CKD progression) with finerenone persists after hospitalization for heart failure (HHF). METHODS AND RESULTS: This post hoc analysis utilized the FIDELITY dataset pooled from the phase 3 FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049) trials, comprising adults with CKD and T2D on optimized renin-angiotensin system inhibitor treatment, randomized 1:1 to finerenone or placebo. Participants included experienced HHF between 4 months post randomization and study end. The key outcome was change in chronic eGFR slope (eGFR estimated from serum creatinine) before and after HHF. To avoid confounding from serum creatinine changes preceding and following HHF, eGFR values ±90 (primary analysis), ±120, and ±150 days from HHF were excluded. Baseline characteristics, medications, and mean hospital stay length were generally balanced between treatment groups. For the primary analysis, both the pre-HHF and post-HHF mean change in eGFR declined slower with finerenone versus placebo (between-group difference 2.68 mL/min/1.73 m2/year [95% confidence interval [CI], 0.87 to 4.49] pre-HHF and 0.96 mL/min/1.73 m2/year [95% CI, -0.99 to 2.91] post-HHF). CONCLUSION: Treatment with finerenone is associated with clinically meaningful attenuation of CKD progression in people with CKD and T2D before HHF, and persists post-HHF, suggesting that maintaining finerenone after HHF may continue to confer benefits in attenuating CKD progression.