Finerenone may reduce risk of AF onset in patients with CKD and diabetes

An analysis of the FIDELIO-DKD trial showed that finerenone may decrease new-onset atrial fibrillation or flutter (AFF) in patients who have type 2 diabetes (T2D) and chronic kidney disease (CKD) [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, nonsteroidal, 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/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 effect on finerenone’s protective effect:

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    • Age
    • Sex
    • Kidney characteristics
    • Baseline serum potassium levels
    • Systolic blood pressure
    • Body Mass Index
    • Glycated hemoglobin (HbA1c)
    • Use of glucose -owering therapies

One of the limitations identified with this study is the fact that electrocardiograms were performed only once per year, raising the possibility that asymptomatic AFF may have been missed [2].

1. 
   
   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. 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.

Posted on 19 May, 20216 July, 2021