A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease - Archive ouverte HAL Access content directly
Journal Articles Clinical Kidney Journal Year : 2023

A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease

1 Indiana University School of Medicine and VA Medical Center
2 University of Michigan [Ann Arbor]
3 Department of Medicine, University of Michigan School of Medicine
4 Department of Internal Medicine, University of Texas Southwestern Medical Center
5 Division of Nephrology, Department of Medicine, University of Tennessee, Health Science Center Memphis
6 Department of Medicine, Cumming School of Medicine, University of Calgary
7 NKUA - National and Kapodistrian University of Athens
8 "Attikon" University Hospital
9 Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University
10 Hospital Universitario 12 de Octubre [Madrid]
11 Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12
12 Faculty of Sport Sciences, European University of Madrid
13 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
14 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
15 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
16 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
17 Hôpital Princesse Grace [Monaco]
18 ITU - IT University of Copenhagen
19 Steno Diabetes Center of Copenhagen
20 PUCPR - Pontifícia Universidade Católica do Paraná
21 Arbor Research Collaborative for Health
22 DZHK - German Center for Cardiovascular Research
23 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
24 BIH - Berlin Institute of Health
25 Bayer Pharma AG [Berlin]
26 US Medical Affairs, Bayer US LLC Pharmaceuticals
27 Research and Development, Integrated Analysis Statistics, Bayer AG
28 University of Chicago


ABSTRACT Background Mineralocorticoid receptor antagonists (MRAs) reduce systolic blood pressure (SBP) and increase serum potassium concentration ([K+]). This indirect comparison investigated any differences in SBP-lowering and hyperkalemia risk between finerenone, a nonsteroidal MRA, and the steroidal MRA spironolactone ± a potassium binder. Methods In FIDELITY (a pooled analysis of FIDELIO-DKD and FIGARO-DKD), a subgroup of patients with treatment-resistant hypertension (TRH) and chronic kidney disease meeting eligibility criteria of the AMBER trial were identified (FIDELITY-TRH). The main outcomes were mean change in SBP, incidence of serum [K+] ≥5.5 mmol/L and hyperkalemia-associated treatment discontinuation. Results at ∼17 weeks were compared with 12 weeks from AMBER. Results In 624 FIDELITY-TRH patients and 295 AMBER patients, the least squares mean change in SBP (mmHg) from baseline was −7.1 for finerenone and −1.3 for placebo {between-group difference −5.74 [95% confidence interval (CI) −7.99 to −3.49], P < .0001} versus −11.7 for spironolactone + patiromer and −10.8 for spironolactone + placebo [between-group difference −1.0 (95% CI −4.4–2.4), P = .58]. The incidence of serum [K+] ≥5.5 mmol/L was 12% for finerenone and 3% for placebo versus 35% with spironolactone + patiromer and 64% with spironolactone + placebo. Treatment discontinuation due to hyperkalemia was 0.3% for finerenone and 0% for placebo versus 7% for spironolactone + patiromer and 23% for spironolactone + placebo. Conclusions In patients with TRH and chronic kidney disease compared with spironolactone with or without patiromer, finerenone was associated with a lower SBP reduction and lower risk of hyperkalemia and treatment discontinuation. Trial Registration: AMBER (NCT03071263), FIDELIO-DKD (NCT02540993), FIGARO-DKD (NCT02545049)
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hal-04023880 , version 1 (10-03-2023)


Attribution - NonCommercial - CC BY 4.0



Rajiv Agarwal, Bertram Pitt, Biff F Palmer, Csaba P Kovesdy, Ellen Burgess, et al.. A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease. Clinical Kidney Journal, 2023, 16 (2), pp.293-302. ⟨10.1093/ckj/sfac234⟩. ⟨hal-04023880⟩
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