Physicians' Academy for Cardiovascular Education

Greater cardioprotective effects of nonsteroidal MRA in CKD and T2D patients with anemia

News - Sep. 5, 2023

Effect of finerenone in patients with chronic kidney disease and type 2 diabetes by baseline anaemia status: a FIDELITY analysis

Presented at the ESC Congress 2023 by: Ajay Singh, MD - Boston, MA, USA

Introduction and methods

The FIDELITY (FInerenone in chronic kiDney diseasE and type 2 diabetes: Combined FIDELIO-DKD and FIGARO-DKD Trial programme analYsis) prespecified pooled analysis previously showed that the selective, nonsteroidal MRA finerenone reduces the risk of CV outcomes and slows CKD progression compared with placebo in patients with CKD and T2D. Anemia is a common complication in patients with CKD and diabetes. Previous observational studies have associated anemia with increased risk of adverse CV and renal outcomes in patients with CKD. The aim of this post-hoc analysis of FIDELITY was to investigate the effect of finerenone on CV and renal outcomes in patients with anemia compared with patients without anemia.

A total of 13,026 patients with CKD and T2D were included in the FIDELITY dataset. Patients on a maximum tolerated dose of single RAASi and serum potassium level of ≤4.8 mmol/l were included. Patients with symptomatic HFrEF were excluded in this analysis. Anemia was defined as an Hb<12 g/dl in women and Hb <13 g/dl in men. Moderate to severe anemia was defined as an Hb ≤10 g/dl. In the FIDELITY dataset, 4293 patients had anemia, whereas 8714 patients had no anemia.

The primary outcomes were: (1) a CV composite consisting of time to CV death, non-fatal MI, non-fatal stroke or hospitalization for HF; (2) a kidney composite consisting of time to kidney failure, sustained ≥57% decrease in eGFR from baseline, or kidney death; (3) hospitalization for HF; and (4) all-cause mortality.

Main results


This post-hoc analysis of FIDELITY showed that finerenone has beneficial effects on CV and renal outcomes compared with placebo in patients with anemia, CKD and T2D. The effect of finerenone on the primary CV composite outcome was significantly greater in patients with anemia vs. no anemia at baseline. Treatment with finerenone increased the number of hyperkalemia events in patients with and without anemia. “The take-home message is that the cardioprotective effect of finerenone observed in the FIDELTY dataset is likely to be preserved and more pronounced in patients with anemia versus those who do not have anemia.” , according to Ajay Singh.

- Our reporting is based on the information provided at the ESC Congress 2023 -

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