Home > Cardiology > ACC 2021 > Electrophysiology > Finerenone reduces the risk of AF onset in patients with CKD and diabetes

Finerenone reduces the risk of AF onset in patients with CKD and diabetes

Presented by
Prof. Gerasimos Filippatos, Attikon University Hospital, Greece
Conference
ACC 2021
Trial
Phase 3, FIDELIO-DKD
An analysis of the FIDELIO-DKD trial demonstrated that finerenone decreased new-onset atrial fibrillation or flutter (AFF) in patients who have type 2 diabetes (T2D) and chronic kidney disease (CKD) irrespective of AFF history at baseline [1,2].

T2D and CKD are both promoters of AFF via structural and/or electrical remodelling, which is triggered by activation of mineralocorticoid receptors. Finerenone is a novel, non-steroidal, selective mineralocorticoid receptor antagonist with anti-inflammatory and anti-fibrotic effects.

Prof. Gerasimos Filippatos (Attikon University Hospital, Greece) presented a prespecified analysis of the FIDELIO-DKD trial (NCT02540993) [1]. The analysis examined the cardiorenal effects and impact of finerenone on new-onset AFF in participants with T2D and CKD. The multicentre, double-blinded, phase 3 FIDELIO-DKD trial randomised 5,674 participants to receive either finerenone or a placebo. Of the 5,674 participants, 461 (8.1%) had AFF at baseline, while 5,213 (91.9%) did not. Of the 5,213 participants with no pre-existing AFF, 2,593 (49.7%) received finerenone, and 2,620 (50.3%) participants received a placebo.

The primary endpoint was a composite of kidney failure, a sustained decrease of ≥40% in renal function, or renal death. The key secondary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalisation for heart failure. Both endpoints were analysed by AFF history.

New-onset AFF occurred in 82 (3.2%) patients in the finerenone arm, and 117 (4.5%) patients in the placebo arm, yielding an incidence rate per 100 patient-years of 1.20 and 1.72, respectively, with a hazard ratio of 0.71 (95% CI 0.53–0.94; P=0.0164) and an absolute risk reduction of 1.3%. Prof. Filippatos noted that the following baseline characteristics seemed to have no impact on the protective effects of finerenone: age, sex, kidney characteristics, baseline serum potassium levels, systolic blood pressure, body mass index, glycated haemoglobin (HbA1c), nor use of glucose-lowering therapies. Baseline AFF did not appear to have a statistically significant impact on the effect of finerenone in either primary or secondary endpoints (P for interaction 0.16 and 0.85, respectively) [2].

One of the limitations of this study is that electrocardiograms were performed only once per year, raising the possibility that asymptomatic AFF may have been missed [3].


    1. Fillipatos G. Finerenone And New Onset of Atrial Fibrillation or Flutter in Patients with Chronic Kidney Disease and Type 2 Diabetes. Abstract 411–16, ACC 2021 Scientific Session, 15–17 May.
    2. Fillipatos G, et al. J. Am. Coll. Cardiol. 2021, May 17. DOI: 10.1016/j.jacc.2021.04.079.
    3. Naccarelli GV, et al. J. Am. Coll. Cardiol. 2021, May 17. DOI: 10.1016/j.jacc.2021.04.080.

 

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