Kidney Week

Abstract: FR-OR100

Finerenone and Kidney Outcomes in Patients with Heart Failure: The FINEARTS-HF Trial

Session Information

• High-Impact Clinical Trials - 1
  October 25, 2024 | Location: Hall D, Convention Center
  Abstract Time: 10:35 AM - 10:50 AM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Finnian R. McCausland, MBChB, MS, FASN

• Vaduganathan, Muthiah, Brigham and Women's Hospital, Boston, Massachusetts, United States

Muthiah Vaduganathan, MD, MPH

• Claggett, Brian, Brigham and Women's Hospital, Boston, Massachusetts, United States

Brian Claggett, MS, PhD

• Kulac, Ian J, Brigham and Women's Hospital, Boston, Massachusetts, United States

Ian J Kulac, MS

• Desai, Akshay, Brigham and Women's Hospital, Boston, Massachusetts, United States

Akshay Desai, MD, MPH

• Jhund, Pardeep, University of Glasgow, Glasgow, United Kingdom

Pardeep Jhund, MBChB, PhD

• Henderson, Alasdair D, University of Glasgow, Glasgow, United Kingdom

Alasdair D Henderson, PhD

• Brinker, Meike Daniela, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany

Meike Daniela Brinker, DrMed, MD

• Perkins, Robert M., Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany

Robert M. Perkins, MD, MPH

• Scheerer, Markus, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany

Markus Scheerer, PhD

• Schloemer, Patrick, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany

Patrick Schloemer, PhD

• Lam, Carolyn S.P., National Heart Centre Singapore, Singapore, Singapore

Carolyn S.P. Lam, MBBS, PhD

• Senni, Michele, Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, Bergamo, Italy

Michele Senni, MD

• Shah, Sanjiv, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Sanjiv Shah, MD

• Voors, Adriaan A., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands

Adriaan A. Voors, MD

• Zannad, Faiez, INSERM, Paris, Île-de-France, France

Faiez Zannad, MD, PhD

• Pitt, Bertram, University of Michigan, Ann Arbor, Michigan, United States

Bertram Pitt, MD

• McMurray, John, University of Glasgow, Glasgow, United Kingdom

John McMurray, MD, MBChB

• Solomon, Scott D., Brigham and Women's Hospital, Boston, Massachusetts, United States

Scott D. Solomon, MD

Background

Finerenone has kidney protective effects in patients with chronic kidney disease (CKD) with type 2 diabetes, but effects on kidney outcomes in patients with heart failure (HF) with and without diabetes and/or CKD are not known.

Methods

FINEARTS-HF was a global, randomized clinical trial of finerenone vs. placebo among patients with HF with mildly reduced or preserved ejection fraction. A secondary outcome was a sustained ≥50% eGFR decline or kidney failure (sustained eGFR decline <15 mL/min/1.73m²; initiation of chronic dialysis; renal transplant). In this prespecified analysis, we also report effects of finerenone on: 1) sustained ≥57% eGFR decline or kidney failure; 2) changes in UACR.

Results

Among 6,001 participants, mean eGFR was 62±20mL/min/1.73m²; 48% had eGFR<60mL/min/1.73m². Overall, 5,797 had baseline UACR data (median 18 [7, 67]mg/g; UACR<30mg/g: 61%; 30-<300mg/g: 30%; ≥300mg/g: 10%). Over 2.6 years median follow-up, the incidence of the composite kidney outcome (≥50% eGFR decline or kidney failure) was low and not affected by finerenone (75 vs. 55 events; HR 1.33; 95%CI 0.94,1.89). Similar results were observed for ≥57% eGFR decline or kidney failure (41 vs. 31 events; HR 1.28; 95%CI 0.80, 2.05). Finerenone reduced UACR by 30% (95%CI 25%, 34%) by 6 months vs. placebo, an effect that persisted throughout follow-up (Fig.), irrespective of diabetes (P_interaction=0.48). Among those with baseline UACR<300mg/g, finerenone reduced the risk of new-onset of macroalbuminuria by 38% (HR 0.62; 95%CI 0.53, 0.73), irrespective of diabetes (P_interaction=0.96).

Conclusion

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.

Funding

• Commercial Support – Bayer