Finerenone improves renal and cardiovascular outcomes in CKD and T2D, as demonstrated in the FIDELIO and FIGARO trials. While the ADA guidelines advise finerenone for residual renal risk, Canadian guidelines lack such recommendations. Previous studies established the applicability of the FIDELIO and FIGARO inclusion criteria to the US population. This study aims to assess if these criteria similarly apply to the Canadian population.
We applied the FIDELIO and FIGARO trial criteria to Canadians with T2D in a community endocrinology setting, who were already optimized for renal risk with RAAS and SGLT2 therapy.
Of 369 individuals with T2D optimized on RAAS and SGLT2 inhibitors, 99 (27%) met FIDELIO or FIGARO criteria. Population characteristics were comparable with the inclusion trials, with median age 71, mean A1c 7.7%, mean eGFR 57, median uACR 284.9 mg/g, and mean SBP 132. Our study population had a higher prevalence of prior myocardial infarction compared to those in the inclusion trials (26.2% vs 7.4% and 13.2%, p <0.05).
Despite Health Canada approval of finerenone, adoption into clinical practice remains slow. We found that 27% of individuals carry residual renal risk despite optimization. The higher proportion of patients in our study with history of cardiovascular disease emphasizes the need to implement finerenone into Canadian guidelines.
A. Jazdarehee: None. A.B. Jain: Advisory Panel; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Advisory Panel; Amgen Inc. Speaker's Bureau; Amgen Inc., AstraZeneca. Advisory Panel; AstraZeneca. Speaker's Bureau; Care to Know, CCRN, Connected in Motion, CPD Network, Dexcom, Diabetes Canada, Eli Lilly, GSK, HLS Therapeutics, Janssen, Master Clinician Alliance, MDBriefcase, Merck, Medtronic, Moderna, Novartis, N. Advisory Panel; Bausch Healthcare, Bayer,, Dexcom, Eli Lilly, Gilead Sciences, GSK, HLS Therapeutics, Insulet, Janssen, Medtronic, Novo Nordisk, Partners in Progressive Medical Education, Pfizer, PocketPills, Roche,.
