Impact of finerenone on chronic kidney disease progression in Chinese patients with type 2 diabetes: a FIGARO-DKD subgroup analysis

Ping Li^1,2Hongguang Zheng³Jianhua Ma⁴Weiping Lu⁵Ling Li⁶Fang Liu⁷Qing Su⁸Yuxiu Li⁹Yi Fang¹⁰Zhaohui Mo¹¹Fei Xiong¹²Aiping Yin¹³Ying Zhang¹⁴Li Wang¹⁵Meike Brinker¹⁶Luke Roberts¹⁷Dalong Zhu¹Simone Pilgrim^18*

• ¹Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
• ²Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, China
• ³General Hospital of Northern Theater Command, Shenyang, China
• ⁴Nanjing First Hospital, Nanjing, China
• ⁵Huaian No.1 People’s Hospital, Jiangsu, China
• ⁶Shengjing Hospital of China Medical University, Shenyang, China
• ⁷West China Hospital, Sichuan University, Chengdu, China
• ⁸Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
• ⁹Peking Union Medical College Hospital, Beijing, China
• ¹⁰5th Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
• ¹¹The Third Xiangya Hospital of Central South University, Changsha, China
• ¹²Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei Province, China
• ¹³The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
• ¹⁴Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
• ¹⁵Research and Development Beijing, Bayer Healthcare Company Limited, Beijing, China
• ¹⁶Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany
• ¹⁷Clinical Development, Bayer PLC, Reading, United Kingdom
• ¹⁸Healthcare Consultancy Group, London, United Kingdom

Type 2 diabetes (T2D) is a considerable and growing burden in the Chinese population, and affected adults are at high risk of developing chronic kidney disease (CKD). This subgroup analysis of the FIGARO-DKD trial explored the cardiovascular and kidney benefits of finerenone in Chinese patients with CKD and T2D on optimized renin-angiotensin system blockade.Patients with urine albumin-to-creatinine ratio (UACR) ≥30-<300 mg/g and estimated glomerular filtration rate (eGFR) ≥25-≤90 mL/min/1.73 m 2 , or UACR ≥300-≤5000 mg/g and eGFR ≥60 mL/min/1.73 m 2 , were randomized to finerenone or placebo. The primary cardiovascular composite outcome was time to cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure. The secondary kidney composite outcome was time to kidney failure, sustained eGFR decline ≥40% from baseline, or kidney-related death.A total of 325 Chinese patients were included. Finerenone resulted in a numerical decrease in decreased the risk of the cardiovascular composite outcome (hazard ratio 0.91; 95% confidence interval 0.50-1.67) and a significantly reduced the risk of the key secondary kidney outcome (hazard ratio 0.48; 95% confidence interval 0.29-0.79; p = 0.0029). The incidence of investigator-reported hyperkalemia was high across both treatment arms. Nevertheless, the incidence of hyperkalemia leading to hospitalization and treatment discontinuation was low across treatment arms.Finerenone significantly reduced the composite kidney outcome, and showed a trend to reduce cardiovascular outcomesbenefits, in Chinese patients, withand demonstrated an acceptable safety profile in Chinese patients.