Initial Decline in Glomerular Filtration Rate With Finerenone in HFmrEF/HFpEF: A Prespecified Analysis of FINEARTS-HF.
Summary
Among 5,587 patients with baseline and 1-month eGFR, a ≥15% decline occurred in 18.2% overall (23.0% finerenone vs 13.4% placebo). An early eGFR drop predicted worse outcomes on placebo (adjusted rate ratio 1.50) but not with finerenone (1.07), supporting continuation of finerenone despite initial renal dips.
Key Findings
- ≥15% eGFR decline at 1 month occurred in 23.0% with finerenone vs 13.4% with placebo (OR 1.95, 95% CI 1.69–2.24).
- Early eGFR decline predicted worse outcomes on placebo (adjusted rate ratio 1.50, 95% CI 1.20–1.89).
- The association was attenuated and not significant with finerenone (adjusted rate ratio 1.07, 95% CI 0.84–1.35).
Clinical Implications
Clinicians should anticipate a modest early eGFR decline with finerenone in HFmrEF/HFpEF and avoid premature discontinuation absent other safety concerns. Monitoring and patient counseling are essential.
Why It Matters
Addresses a common clinical dilemma of stopping MRAs after eGFR dips and provides randomized evidence that the early decline with finerenone is not harmful.
Limitations
- Focus on 1-month eGFR change; longer-term renal trajectories not detailed in abstract
- Mechanistic drivers of eGFR dip not directly assessed
Future Directions
Define thresholds and monitoring protocols to safely continue finerenone; evaluate similar patterns across EF spectrum and in diverse CKD phenotypes.
Study Information
- Study Type
- RCT (prespecified secondary analysis)
- Research Domain
- Treatment
- Evidence Level
- I - Analysis embedded in a randomized, placebo-controlled trial
- Study Design
- OTHER