FINEARTS-HF Prespecified Analysis Results: Finerenone and Renal Outcomes

Finerenone provides renoprotective effects in patients with CKD and type 2 diabetes, but there are few data available on kidney outcomes among patients with heart failure (HF) with and without diabetes and/or CKD.

During an oral presentation at ASN Kidney Week 2024, researchers, led by Finnian R. McCausland, MD, reported prespecified analysis results from FINEARTS-HF. The presentation was titled Finerenone and Kidney Outcomes in Patients With Heart Failure: The FINEARTS-HF Trial.

The global, randomized clinical trial compared finerenone to placebo in a study population of patients with HF and mildly reduced or preserved ejection fraction. Outcomes of interest included a sustained decline of ≥50% in eGFR or kidney failure, defined as sustained eGFR decline ≤15 mL/min/1.73 m², initiation of chronic dialysis, or renal transplant. During the session, the researchers reported the effects of finerenone on sustained ≥57% eGFR decline or kidney failure and changes in urine albumin-to-creatinine ratio (UACR).

The study included 6,001 patients. Mean eGFR was 62 mL/min/1.73 m², and 48% had eGFR <60 mL/min/1.73 m². Of the 6,001 patients, 5,797 had baseline UACR data: median 18 mg/g; 61% had UACR <30 mg/g; 30% had UACR 30 to <300 mg/g; and 10% had UACR ≥300 m/g.

During a median of 2.6 years of follow-up, the incidence of the composite kidney outcome was low and not affected by finerenone (75 vs 55 events; HR 1.33; 95% CI, 0.94-1.89). Results were similar for ≥57% decline in eGFR or kidney failure (41 vs 31 events; HR, 1.28; 95% CI, 0.80-2.05). In the finerenone group at six months, UACR was reduced by 30% (95% CI, 25%-34%) compared to placebo. The effect persisted throughout follow-up in patients with and without diabetes (P_interaction=.48). In patients with baseline UACR ≤300 mg/g, the risk of new-onset of macroalbuminuria was reduced by 38% with finerenone (HR, 0.62; 95% CI, 0.53-0.73), in patients with and without diabetes (P_interaction=.96).

“Finerenone did not modify eGFR-based kidney outcomes but led to early and sustained reductions in albuminuria and reduced the risk of new-onset of macroalbuminuria among patients in FINEARTS-HF at low risk of adverse kidney outcomes,” the researchers said.

Source: McCausland FR, Vaduganathan M, Claggett B, et al. Finerenone and kidney outcomes in patients with heart failure: the FINEARTS-HF trial. FR-OR100. Abstract of an oral presentation at the American Society of Nephrology Kidney Week 2024; October 25, 2024; San Diego, California. Support for the study was provided by Bayer.