A 58-year-old woman with diabetes mellitus (DM) and chronic kidney disease (CKD) is seen by her endocrinologist. She is treated with lisinopril and empagliflozin.
Her blood pressure (BP) is 140/90 mm Hg.
Laboratory study results include urinary albumin-to-creatinine ratio 400 mg/g, hemoglobin A1c concentration 6.4%, estimated glomerular filtration rate 55 mL/min/1.73 m2, and potassium level 3.9 mEq/L.
The correct answer is: A. Finerenone.
Finerenone, a nonsteroidal mineralocorticoid-receptor antagonist, has been shown to reduce the progression of CKD and prevent HF events in patients with type 2 DM and albuminuria who are already receiving maximally tolerated angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy (and, in many cases, sodium-glucose cotransporter-2 inhibitor therapy) in multiple large-scale randomized controlled trials, such as the FIDELIO-DKD (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) and FIGARO-DKD (Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease) trials.
Amlodipine is a calcium channel blocker that lowers BP but does not reduce albuminuria or prevent HF in the setting of CKD. Carvedilol is a beta-blocker that is beneficial in treating HF with reduced ejection fraction but is not used for primary prevention of HF or CKD progression in patients with DM and CKD but without HF. Metformin is effective for glycemic control but does not improve kidney or HF outcomes in the setting of CKD with albuminuria.
This patient case quiz is part of the larger Managing HF Across the Spectrum: From Recognizing Symptoms to Implementing Appropriate Treatment initiative, supported by Bayer. To visit the Managing HF Across the Spectrum page and access additional educational activities on this topic, click here.
References
- Bakris GL, Agarwal R, Anker SD, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383(23):2219-2229. doi:10.1056/NEJMoa2025845
- Pitt B, Filippatos G, Agarwal R, et al. Cardiovascular events with finerenone in kidney disease and type 2 diabetes. N Engl J Med. 2021;385(24):2252-2263. doi:10.1056/NEJMoa2110956
- Agarwal R, Filippatos G, Pitt B, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43(6):474-484. doi:10.1093/eurheartj/ehab777
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