A randomized, double-blind, placebo-controlled trial in chronic kidney disease (CKD) and type 2 diabetes (T2D) concluded that treatment with finerenone reduced risks of CKD progression and cardiovascular (CV) events. Between September 2015 and June 2018, 5734 patients with CKD and T2D were randomly assigned in a 1:1 ratio to receive finerenone (a nonsteroidal, selective mineralocorticoid receptor antagonist) or placebo. Compared to placebo, finerenone reduced the risk of the composite CKD (kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes, hazard ratio 0.82), and CV (CV death, myocardial infarction, stroke, or hospitalization for heart failure, hazard ratio 0.86) outcomes over a median follow-up of 2.6 years. Overall, the frequency of adverse events was similar in the two groups, although the incidence of hyperkalemia-related discontinuation of the trial regimen was higher with finerenone than with placebo (2.3% and 0.9%, respectively). The findings support finerenone to be a meaningful treatment option for patients with CKD and T2D, in addition to control of hypertension and hyperglycemia, a renin–angiotensin system blocker and, more recently, a sodium–glucose cotransporter 2 inhibitor. Source: https://www.nejm.org/; https://www.ahajournals.org/
