Finerenone linked to improved KDIGO risk categories in T2D and CKD patients

This was a post hoc subanalysis of a randomized controlled trial, examining patients with type 2 diabetes and chronic kidney disease. The analysis compared outcomes in those treated with finerenone versus placebo over a 36-month follow-up period, focusing on changes in KDIGO risk categories and their relationship to a cardiovascular composite outcome.

The main results showed finerenone was associated with a higher likelihood of KDIGO risk category improvement (OR 1.47, 95% CI 1.31-1.65; p < 0.0001) and a lower likelihood of worsening (OR 0.83, 95% CI 0.77-0.90; p < 0.0001) compared to placebo. Furthermore, improvement in KDIGO risk category was associated with a reduced risk of the CV composite outcome (HR 0.82, 95% CI 0.68-0.99; p = 0.043), while worsening was associated with an increased risk (HR 1.29, 95% CI 1.06-1.56; p = 0.01).

Safety and tolerability data were not reported in this subanalysis. The key limitation is that this is a post hoc subanalysis, which means the findings are hypothesis-generating and should not be considered definitive evidence of causality. The study was funded by Bayer AG, the manufacturer of finerenone.

For clinical practice, these results suggest a potential link between finerenone's effect on CKD progression (as measured by KDIGO categories) and cardiovascular risk in this population. However, clinicians should interpret these associations cautiously, recognizing that KDIGO category changes are surrogate endpoints and that the analysis does not establish direct causation.