Nephro Trial Files: Finerenone on Kidney Outcomes in HF, Semaglutide in CKD + Obesity, and Sparsentan vs. Irbesartan in FSGS
Finerenone and Kidney Outcomes in Patients With Heart Failure (FINEARTS-HF)
Mc Causland FR et al. JACC (January 2025)
Bottom Line: This randomized trial examined the effects of finerenone on kidney outcomes in patients with heart failure with mildly reduced or preserved ejection fraction. The study included 6001 participants and found no significant difference in the primary outcome of sustained ≥50% eGFR decline or kidney failure between finerenone and placebo. However, finerenone did lead to a greater reduction in initial eGFR and reduced the risk of new-onset micro- and macroalbuminuria. The study was not blinded and was conducted over 2.6 years. The patient population consisted of patients with heart failure with mildly reduced or preserved ejection fraction. The intervention group received finerenone, while the comparator group received placebo. The study was funded by Bayer.
Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes
Apperloo EM et al. Nature Medicine (October 2024)
Bottom Line: This was a randomized, placebo-controlled, double-blind clinical trial conducted in adults with chronic kidney disease (CKD) and body mass index ≥27 kg m-2. The study duration was 24 weeks and the primary outcome was the percentage change from baseline in urine albumin-to-creatinine ratio (UACR). The intervention group received semaglutide 2.4 mg per week while the comparator group received placebo. The sample size was 101 participants and the primary outcome result for the intervention group was a -52.1% reduction in UACR. Gastrointestinal adverse events were more common in the semaglutide group. The study concluded that semaglutide treatment for 24 weeks resulted in a clinically meaningful reduction in albuminuria in patients with overweight/obesity and non-diabetic CKD.
Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis
Rheault MN et al. NEJM (November 2023)
Bottom Line: This phase 3, 108-week trial compared the efficacy and safety of sparsentan (dual endothelin-angiotensin receptor antagonist) to irbesartan (active control) in patients with FSGS (without known secondary causes) aged 8 to 75 years. The primary outcome was FSGS partial remission of proteinuria at 36 weeks, with a statistically significant difference between the two groups (42.0% vs 26.0%). However, at the final analysis at week 108, there were no significant differences in eGFR slope between the two groups. Both treatments had similar safety profiles and adverse event frequencies.
Nephro Trial Files Issue #NPH-2025-04
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