Albuminuria reduction accounts for treatment effect on CKD outcomes in T2D

Early albuminuria reduction with finerenone in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) is responsible for a huge proportion of the treatment effect against CKD progression and facilitates a modest amount of the effect against cardiovascular outcomes, reports a study.

A post hoc mediation analysis was conducted using pooled data from two phase III, double-blind trials of finerenone in 12,512 patients with CKD and T2D.

The authors performed separate mediation analyses for the composite kidney (ie, kidney failure, sustained ≥57-percent decrease in estimated glomerular filtration rate from baseline, or kidney disease death) and cardiovascular outcomes (ie, cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure).

Median urine albumin-to-creatinine ratio (UACR) at baseline was 514 mg/g. A reduction in UACR of 30 percent or more occurred in 3,338 (53.2 percent) patients in the finerenone group and in 1,684 (27.0 percent) patients in the placebo group.

Analysed as a continuous variable, a decrease in UACR facilitated 84 percent of the treatment effect on the kidney and 37 percent of the effect on cardiovascular outcomes.

Analysis of the change in UACR as a binary variable (ie, whether the guideline-recommended 30-percent reduction threshold was met) revealed that the proportions mediated were 64 percent for kidney outcomes and 26 percent for cardiovascular outcomes.

“The current findings are not readily extendable to other drugs,” the authors said.

“In patients with CKD and T2D, finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces cardiovascular and kidney failure outcomes,” the authors said. “Finerenone also lowers the UACR.”