## Key takeaways:
- Finerenone was associated withFrailty may increase with reduced kidney function, according to study background, and “fast decline in eGFR has been associated with incident frailty in people aged 70 years.” in addition, “type 2 diabetes and associated complications are also linked to an increase in frailty.”
Considering that frailty could lead to worse clinical outcomes for certain patients, researchers sought to examine the effects of finerenone (Kerendia, Bayer) in CKD and type 2 diabetes via a post analysis of the FIDELITY trial.
Rossing and colleagues conducted a prespecified, pooled analysis to investigate each of these trials and compare the efficacy and safety of finerenone vs.placebo for patients with frailty.
FIDELITY included 12,990 participants aged at least 18 years with CKD and type 2 diabetes and baseline serum potassium level of 4.8 mmol/L or lower,who were evaluated between September 2015 and October 2018. Participants had either a urine albumin-to-creatinine ratio between 30 mg/g and 300 mg/g,and an eGFR between 25 mL/min/1.73 m2 and 90 mL/min/1.73 m2; or a urine albumin-to-creatinine ratio between 300 mg/g to 5,000 mg/g, and eGFR above 25 mL/min/1.73 m2. Participants received standard of care therapy with a maximum tolerated renin-angiotensin system inhibitor labeled dose.
the researchers randomly assigned patients to 10 mg or 20 mg finerenone daily or placebo.
Researchers assessed frailty with the Rockwood cumulative deficit approach including 30 clinical characteristics, and main outcomes were a kidney and cardiovascular composite.
Composite kidney outcomes were kidney failure, sustained decrease of at least 57% in eGFR or kidney-related death, whereas cardiovascular outcomes included cardiovascular death, nonfatal myocardial infarction, nonfatal stroke or hospitalization for heart failure.
Findings showed finerenone lowered the risk of primary kidney and cardiovascular outcomes despite baseline frailty. The risk for each condition was consistent among frailty subgroups, according to the researchers, with statistically insignificant interaction.finerenone treatment also was associated with reductions in urine albumin-to-creatinine ratios and eGFR decline during 48 months across all frailty tiers. Researchers observed notable reductions when comparing the frailest quartiles against lower frailty tiers.
Despite an increase in serious adverse events with rising frailty, according to rossing and colleagues, both treatment groups had similar risks for adverse events and hyperkalemia.
“It is important to keep in mind that frailty is not only a concern in older people; therefore, this efficacy and safety analysis is clinically relevant across the spectrum of people with CKD and type 2 diabetes,” the researchers wrote, “and finerenone should be considered in this population regardless of the severity of frailty.”
for more details:
Peter Rossing, MD, DMSC, can be reached at peter.rossing@regionh.dk.
Navigating the Evolving Landscape of Chronic Kidney Disease Management
Chronic Kidney Disease (CKD) represents a significant and growing global health challenge. Affecting an estimated 1 in 10 adults worldwide – roughly 850 million people – the prevalence of CKD is steadily increasing, driven by factors like diabetes, hypertension, and an aging population. Beyond the sheer number of individuals impacted, CKD places a considerable burden on healthcare systems and economies globally. Effective management strategies are therefore crucial, and the field is undergoing continuous evolution, incorporating new research, technologies, and a more patient-centric approach.
Understanding the Stages and Progression of CKD
CKD isn’t a single disease, but rather a spectrum of structural and functional abnormalities in the kidneys. It’s typically categorized into five stages, based on glomerular filtration rate (GFR), a measure of kidney function. Early stages (1 & 2) often present with few or no symptoms, making early detection challenging. however, even in these initial phases, subtle indicators like slightly elevated creatinine levels or protein in the urine can signal underlying kidney damage.
Progression through the stages is not unavoidable.Aggressive management of underlying conditions like diabetes and hypertension, alongside lifestyle modifications, can significantly slow the decline in kidney function. Think of it like managing a slowly leaking tire – consistent attention and preventative measures can delay the need for a complete replacement (dialysis or kidney transplant).
The role of Novel Biomarkers in Early Detection
Traditional markers of kidney function, such as creatinine and blood urea nitrogen (BUN), often don’t reflect early kidney damage. This is because they only become elevated when a significant amount of kidney function has already been lost. Consequently, research is increasingly focused on identifying and utilizing novel biomarkers for earlier detection.
These include markers of tubular injury, such as neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1), which can detect damage at a cellular level before changes in GFR are apparent. Furthermore, advancements in urine proteomics are allowing for the identification of complex protein signatures that can predict CKD progression and response to treatment. The potential of these biomarkers lies in enabling proactive intervention, potentially preventing or delaying the onset of end-stage renal disease (ESRD).
Pharmacological Advances in CKD Treatment
While ther’s no cure for CKD,significant strides have been made in pharmacological interventions to manage complications and slow disease progression.
SGLT2 Inhibitors: Originally developed for diabetes management, Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors have demonstrated remarkable kidney-protective effects, even in individuals without diabetes. Clinical trials have shown these drugs can reduce the risk of CKD progression, cardiovascular events, and hospitalization in patients with CKD.
Non-Steroidal Mineralocorticoid Receptor Antagonists (MRA): These newer MRAs offer a more targeted approach to blocking aldosterone, a hormone that contributes to kidney inflammation and fibrosis, with potentially fewer side effects than traditional MRAs. Endothelin Receptor Antagonists: These medications are showing promise in reducing proteinuria, a key marker of kidney damage, and slowing the progression of CKD, especially in specific patient populations.Beyond Medication: lifestyle and Supportive Care
Effective CKD management extends far beyond medication. Lifestyle modifications play a critical role in preserving kidney function and improving overall health.
Dietary Management: A carefully planned diet, frequently enough low in protein, phosphorus, and sodium, can definitely help reduce the workload on the kidneys and manage associated complications. Working with a registered dietitian specializing in renal nutrition is essential.
Blood Pressure Control: Maintaining optimal blood pressure is paramount. This often requires a combination of lifestyle changes and medication.
Regular Exercise: Physical activity can improve cardiovascular health, blood sugar control, and overall well-being, all of which benefit kidney function.
* Smoking Cessation: smoking accelerates CKD progression and increases the risk of cardiovascular disease.Moreover, supportive care, including regular monitoring, patient education, and psychosocial support, is crucial for empowering individuals to actively participate in their own care and improve their quality of life.
The future of CKD Management: Personalized Medicine and Technology
The future of CKD management is poised to be shaped by personalized medicine and technological advancements. genetic testing may help identify individuals at higher risk of developing CKD or experiencing rapid progression, allowing for targeted preventative strategies.
Telemedicine and remote monitoring technologies are expanding access to care, particularly for patients in rural or underserved areas. Wearable sensors and mobile apps can track vital signs, medication adherence, and dietary intake, providing valuable data for clinicians to optimize treatment plans.
Ultimately, a holistic and proactive approach, combining cutting-edge research, innovative therapies, and a strong emphasis on patient empowerment, will be essential to address the growing challenge of chronic kidney disease and improve the lives of millions worldwide.