Acute eGFR Changes and Their Mediation of Albuminuria Reduction with Empagliflozin and Finerenone
Abstract
Key points: We investigated the effect of empagliflozin, finerenone, and their combination on eGFR decline in people with type 2 diabetes and albuminuria. Acute declines in eGFR occurred more in those on combination therapy, on diuretics, and with higher eGFR; eGFR changes were reversible. Finerenone's additive effect to empagliflozin on urinary albumin-to-creatinine ratio lowering was nonhemodynamic; empagliflozin lowered urinary albumin-to-creatinine ratio in part driven by eGFR change.
Background: eGFR decline is common with sodium-glucose cotransporter 2 inhibitors and renin-angiotensin system inhibitors, often prompting treatment interruption or cessation, limiting cardiorenal benefits. This mostly prespecified COmbinatioN effect of FInerenone anD EmpaglifloziN in Participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint (CONFIDENCE) trial analysis investigated the effect of empagliflozin, finerenone, and their combination on change from baseline in eGFR and its determinants and the relationship of change in eGFR with albuminuria reduction in people with type 2 diabetes and CKD.
Methods: Evaluable participants ( N =790) with type 2 diabetes, CKD, and albuminuria, receiving stable doses of renin-angiotensin system inhibitors, were randomized 1:1:1 to empagliflozin, finerenone, or both. The primary outcome was urinary albumin-to-creatinine ratio (UACR) change from baseline to day 180. We assessed mean eGFR change from baseline at day 14 (acute),…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 790 participants or records.
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