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Efficacy of finerenone in patients with type 2 diabetes, chronic kidney disease and altered markers of liver steatosis and fibrosis: A FIDELITY subgroup analysis

Perakakis, Nikolaos ; Bornstein, Stefan R ; Birkenfeld, Andreas L ; Linkermann, Andreas ; Demir, Münevver ; Anker, Stefan D ; Filippatos, Gerasimos ; Pitt, Bertram ; Rossing, Peter ; Ruilope, Luis M ; Kolkhof, Peter ; Lawatscheck, Robert ; Scott, Charlie ; Bakris, George L ; FIDELIO-DKD and FIGARO-DKD investigators

Wiley-Blackwell Publishing, Inc 2024-01

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  • Título:
    Efficacy of finerenone in patients with type 2 diabetes, chronic kidney disease and altered markers of liver steatosis and fibrosis: A FIDELITY subgroup analysis
  • Autor: Perakakis, Nikolaos ; Bornstein, Stefan R ; Birkenfeld, Andreas L ; Linkermann, Andreas ; Demir, Münevver ; Anker, Stefan D ; Filippatos, Gerasimos ; Pitt, Bertram ; Rossing, Peter ; Ruilope, Luis M ; Kolkhof, Peter ; Lawatscheck, Robert ; Scott, Charlie ; Bakris, George L ; FIDELIO-DKD and FIGARO-DKD investigators
  • Assuntos: Clinic for Endocrinology and Diabetology ; Medicine & health
  • Notas: Perakakis, Nikolaos; Bornstein, Stefan R; Birkenfeld, Andreas L; Linkermann, Andreas; Demir, Münevver; Anker, Stefan D; Filippatos, Gerasimos; Pitt, Bertram; Rossing, Peter; Ruilope, Luis M; Kolkhof, Peter; Lawatscheck, Robert; Scott, Charlie; Bakris, George L; FIDELIO-DKD and FIGARO-DKD investigators (2024). Efficacy of finerenone in patients with type 2 diabetes, chronic kidney disease and altered markers of liver steatosis and fibrosis: A FIDELITY subgroup analysis. Diabetes, Obesity & Metabolism, 26(1):191-200.
    https://www.zora.uzh.ch/id/eprint/255655/
    10.1111/dom.15305
  • Descrição: AIM Investigating the effect of finerenone on liver function, cardiovascular and kidney composite outcomes in patients with chronic kidney disease and type 2 diabetes, stratified by their risk of liver steatosis, inflammation and fibrosis. MATERIALS AND METHODS Post hoc analysis stratified patients (N = 13 026) by liver fibrosis and enzymes: high risk of steatosis (hepatic steatosis index >36); elevated transaminases [alanine transaminase (ALT) >33 (males) and >25 IU/L (females)]; and fibrosis-4 (FIB-4) index scores >3.25, >2.67 and >1.30. Liver enzymes were assessed by changes in ALT, aspartate aminotransferase and gamma-glutamyl transferase. Composite kidney outcome was defined as onset of kidney failure, sustained estimated glomerular filtration rate decline ≥57% from baseline over ≥4 weeks or kidney death. Composite cardiovascular outcome was defined as cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure. RESULTS ALT, aspartate aminotransferase and gamma-glutamyl transferase levels were consistent between treatment groups and remained stable throughout. Finerenone consistently reduced the risk of composite kidney outcome, irrespective of altered liver tests. Higher FIB-4 score was associated with higher incidence rates of composite cardiovascular outcome. Finerenone reduced the risk of composite cardiovascular outcome versus placebo in FIB-4 subgroups by 52% (>3.25), 39% (>2.67) and 24% (>1.30) (p values for interaction = .01, .13 and .03, respectively). CONCLUSIONS Finerenone has neutral effects on liver parameters in patients with chronic kidney disease and type 2 diabetes. Finerenone showed robust and consistent kidney benefits in patients with altered liver tests, and profound cardiovascular benefits even in patients with higher FIB-4 scores who were at high risk of developing cardiovascular complications.
  • Editor: Wiley-Blackwell Publishing, Inc
  • Data de criação/publicação: 2024-01
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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