OBJECTIVE
Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes.
RESEARCH DESIGN AND METHODS
Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30–5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin–angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%.
RESULTS
Of 5,674 patients, 3,637 (64.1%) received insulin at baseline. Overall, 5,663 patients were included in the analysis for HbA1c; 2,794 (49.3%) had baseline HbA1c <7.5% (58 mmol/mol). Finerenone significantly reduced risk of the kidney composite outcome independent of baseline HbA1c level and insulin use (Pinteraction = 0.41 and 0.56, respectively). Cardiovascular composite outcome incidence was reduced with finerenone irrespective of baseline HbA1c level and insulin use (Pinteraction = 0.70 and 0.33, respectively). Although baseline HbA1c level did not affect kidney event risk, cardiovascular risk increased with higher HbA1c level. UACR reduction was consistent across subgroups. Adverse events were similar between groups regardless of baseline HbA1c level and insulin use; few finerenone-treated patients discontinued treatment because of hyperkalemia.
CONCLUSIONS
Finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2D, and risks appear consistent irrespective of HbA1c levels or insulin use.
Objective. To develop the pattern of early cardiovascular disorders in patients with primary hypothyroidism based on the analysis of relationship between patient’s thyroid status and some functional cardiovascular parameters depending on compensation status. Materials and methods. The examination of 163 women aged 62 [55;67] years with primary hypothyroidism was performed. The patients were divided into groups: 1 group included 54 patients aged 62.0 [57;68] years with subcompensated disease, 2 group consisted of 15 patients aged 59 [53;66] years with non-compensated disease and 3 group included 94 patients aged 63 [53;66] years with compensated hypothyroidism. Physical examination, transthoracic echocardiography, assessment of global left ventricle longitudinal strain by speckle tracking method, endothelial function and laboratory tests were performed to all patients. Regression analysis using thyroid stimulating hormone, free T4, age, duration of the disease, cause of hypothyroidism, menopause presence and natural thyroid stimulating hormone logarithm as predictors and some cardiovascular parameters of heart condition and lipid metabolism as dependent valuables was made. Results. Mathematic modeling demonstrated that the combination such factors as age, duration of disease and thyroid stimulating hormone level is the most important in left ventricle remodeling processes. However, the age only has significant influence on intima media thickness. Conclusion. Left ventricle remodeling, morphologic functional status of blood vessel wall and decrease of glomerular filtration rate are basically determined by such modified and non-modified factors as body mass index, age, duration of hypothyroidism and thyroid stimulating hormone level.
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