Research Article
Volume 9 Issue 3 - 2022
Cardiovascular and Renal Outcomes of the New Kid on the Block: FiFi Analysis
Hilaryano da Silva Ferreira* and Joana Lima Lopes
Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
*Corresponding Author: Hilaryano da Silva Ferreira, Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
Received: April 04, 2022; Published: April 26, 2022




Abstract

Finerenone is a selective nonsteroidal mineralocorticoid receptor antagonist that has been shown to reduce the urinary albuminto- creatinine ratio in patients with CKD treated with a renin angiotensin system blocker, improving cardiovascular injury while having smaller effects on serum potassium levels than spironolactone. We aim to assess whether nonsteroidal mineralocorticoid receptor antagonists are effective in the treatment of patients with type 2 diabetes and chronic kidney disease using a systematic review approach. We searched PubMed and screened the resulting records on 10 September 2021. A total of 13026 participants were included in this analysis. Overall cardiovascular outcomes were significantly lower in the finerenone group (RR 0.88 (95% CI 0.81 to 0.96; I2 = 0%; p = 0.004). Cardiovascular death had an RR of 0.88 (95% CI 0.76 to 1.02; I2 = 0%), nonfatal myocardial infarction had an RR of 0.91 (95% CI 0.74 to 1.13; I2 = 8%), and heart failure hospitalizations had an RR of 0.79 (95% CI 0.66 to 0.64; I2 = 23%; p = 0.001). Overall renal outcomes were significantly lower in the finerenone group (RR 0.84 (95% CI 0.79 to 0.90; I2 = 0%; p ≤ 0.00001). Death from renal causes had an RR of 0.86 (95% CI 0.73 to 1.01; I2 = 0%). End-stage kidney disease was lower in the intervention arm (p = 0.05) (RR 0.79 (95% CI 0.63 to 1.00; I2 = 10%). These results suggest that finerenone might have an additional protective effect on the cardiovascular and renal systems that is non-existent with the use of spironolactone and eplerenone.

Keywords: Mineralocorticoid; Receptor; Heart Failure; Chronic Kidney Disease; Type 2 Diabetes

References

  1. Pitt B., et al. “The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators”. New England Journal of Medicine 10 (1999): 709-717.
  2. Pitt B., et al. “Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction”. New England Journal of Medicine 14 (2003): 1309-1321.
  3. Zannad F., et al. “Eplerenone in patients with systolic heart failure and mild symptoms”. New England Journal of Medicine 1 (2011): 11-21.
  4. Buonafine M., et al. “Mineralocorticoid Receptor and Cardiovascular Disease”. American Journal of Hypertension 11 (2018): 1165-1174.
  5. Gansevoort RT., et al. “Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention”. Lancet9889 (2013): 339-352.
  6. Li H., et al. “Changing epidemiology of chronic kidney disease as a result of type 2 diabetes mellitus from 1990 to 2017: Estimates from Global Burden of Disease 2017”. Journal of Diabetes Investigation 3 (2021): 346-356.
  7. Bakris GL., et al. “Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy: A Randomized Clinical Trial”. Journal of the American Medical Association 9 (2015): 884-894.
  8. Pitt B., et al. “Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial”. European Heart Journal 31 (2013): 2453-2463.
  9. Higgins JPT and Green S. “Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]”. The Cochrane Collaboration (2011).
  10. Deeks JJ., et al. “Chapter 10: Analysing data and undertaking meta-analyses”. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane (2022).
  11. Bakris GL., et al. “Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes”. New England Journal of Medicine23 (2020): 2219-2229.
  12. Pitt B., et al. “Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes”. New England Journal of Medicine 24 (2021): 2252-2263.
  13. Cooper LB., et al. “Use of Mineralocorticoid Receptor Antagonists in Patients with Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease”. Journal of the American Heart Association 12 (2017): e006540.
  14. Zannad F., et al. “Eplerenone in patients with systolic heart failure and mild symptoms”. New England Journal of Medicine 1 (2011): 11-21.
  15. Pitt B., et al. “Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure”. Journal of the American College of Cardiology 3 (2005): 425-431.
  16. Tofte N., et al. “Early detection of diabetic kidney disease by urinary proteomics and subsequent intervention with spironolactone to delay progression (PRIORITY): a prospective observational study and embedded randomised placebo-controlled trial”. Lancet Diabetes and Endocrinology 4 (2020): 301-312.
  17. Eschalier R., et al. “Safety and efficacy of eplerenone in patients at high risk for hyperkalemia and/or worsening renal function: analyses of the EMPHASIS-HF study subgroups (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure)”. Journal of the American College of Cardiology 17 (2013): 1585-1593.
  18. Pitt B., et al. “Why are mineralocorticoid receptor antagonists the Cinderella in evidence-based treatment of myocardial infarction complicated with heart failure? Lessons from PARADISE-MI”. European Heart Journal14 (2021): 1428-1431.
  19. Agarwal R., et al. “Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis”. European Heart Journal6 (2021): 474-484.
  20. Sarafidis P., et al. “SGLT-2 inhibitors and GLP-1 receptor agonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease. A consensus statement by the EURECA-m and the DIABESITY working groups of the ERA-EDTA”. Nephrology Dialysis Transplantation 2 (2019): 208-230.
  21. Molitch ME., et al. “Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes”. Kidney International 1 (2015): 20-30.
  22. Palmer SC., et al. “Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials”. British Medical Journal 372 (2021): m4573.
Citation: Hilaryano da Silva Ferreira and Joana Lima Lopes. “Cardiovascular and Renal Outcomes of the New Kid on the Block: FiFi Analysis”. EC Cardiology 9.3 (2022): 03-12.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 09, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.