Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in Chronic Kidney Disease.
| Title: | Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in Chronic Kidney Disease. |
|---|---|
| Authors: | Hanouneh, Mohamad, Le, Dustin, Jaar, Bernard G., Tamargo, Christina, Cervantes, C. Elena |
| Source: | Diagnostics (2075-4418); Jul2024, Vol. 14 Issue 13, p1357, 9p |
| Subject Terms: | ACE inhibitors, ANGIOTENSIN-receptor blockers, MINERALOCORTICOID receptors, CHRONIC kidney failure, TYPE 2 diabetes |
| Abstract: | Background: There have been several recent advances in the care of patients with chronic kidney disease (CKD), including the use of sodium glucose cotransporter 2 (SGLT2) inhibitors and selective mineralocorticoid receptor antagonists (MRAs). There are very few data reporting the outcomes of these treatments in real-world experience. The aim of this retrospective study is to report the effects of SGLT2 inhibitors, finerenone, and their combination in CKD patients in our community-based setting. Methods: Ninety-eight patients with CKD with an estimated glomerular filtration rate (eGFR) between 25 and 90 mL/min per 1.73 m2 and a urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g were included. Patients were divided into three groups: two monotherapy groups of SGLT2 inhibitors or finerenone and a third combination group of therapy with SGLT2 inhibitors for the first 4 months and SGLT2 inhibitors and finerenone subsequently. The primary outcomes were the timing and percentage of patients achieving a >50% reduction in UACR from baseline. Results: Group 1 comprised 52 patients on SGLT2i, group 2 had 22 patients on finerenone, and group 3 had 24 patients on combination therapy. The baseline median UACR and mean eGFR were 513 mg/g and 47.9 mL/min per 1.73 m2 in group 1, 548.0 mg/g and 50.5 mL/min per 1.73 m2 in group 2, and 800 mg/g and 60 mL/min per 1.73 m2 in group 3. At baseline, 71 (72.4%) patients were on the angiotensin-converting enzyme inhibitor (ACEi) or the angiotensin receptor blocker (ARB), and 78 (79.5%) patients had type 2 diabetes. After 8 months of follow-up, a >50% decrease in albuminuria was achieved in 96% of patients in group 3, compared to 50% in group 1 and 59% in group 2 (p-values were <0.01 and <0.01, respectively). There was a statistically but not clinically significant change in mean potassium levels in group 2 (+0.4 mmol/L) compared to either group 1 (0.0 mmol/L with p-value: <0.01) or group 3 (−0.01 mmol/L with p-value: <0.01). However, there was no difference in potassium levels when comparing groups 1 and 3. At the end of the follow-up, the average difference in eGFR was −3.4 (8.8), −5.3(10.1), and −7.8 (11.2) mL/min per 1.73 m2 in groups 1, 2, and 3, respectively, without a statistically significant difference between groups. Conclusions: In this real-world experience in our community setting, the combination of SGLT2 inhibitors and finerenone in our adult patients with CKD was associated with a very significant and clinically relevant reduction in UACR, without an increased risk of hyperkalemia. Combination therapy of SGLT2 inhibitor and finerenone regarding background use of ACEi/ARB is feasible and should be encouraged for further albuminuria reductions in CKD patients. [ABSTRACT FROM AUTHOR] |
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| Database: | Complementary Index |
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| Items | – Name: Title Label: Title Group: Ti Data: Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in Chronic Kidney Disease. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Hanouneh%2C+Mohamad%22">Hanouneh, Mohamad</searchLink><br /><searchLink fieldCode="AR" term="%22Le%2C+Dustin%22">Le, Dustin</searchLink><br /><searchLink fieldCode="AR" term="%22Jaar%2C+Bernard+G%2E%22">Jaar, Bernard G.</searchLink><br /><searchLink fieldCode="AR" term="%22Tamargo%2C+Christina%22">Tamargo, Christina</searchLink><br /><searchLink fieldCode="AR" term="%22Cervantes%2C+C%2E+Elena%22">Cervantes, C. Elena</searchLink> – Name: TitleSource Label: Source Group: Src Data: Diagnostics (2075-4418); Jul2024, Vol. 14 Issue 13, p1357, 9p – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22ACE+inhibitors%22">ACE inhibitors</searchLink><br /><searchLink fieldCode="DE" term="%22ANGIOTENSIN-receptor+blockers%22">ANGIOTENSIN-receptor blockers</searchLink><br /><searchLink fieldCode="DE" term="%22MINERALOCORTICOID+receptors%22">MINERALOCORTICOID receptors</searchLink><br /><searchLink fieldCode="DE" term="%22CHRONIC+kidney+failure%22">CHRONIC kidney failure</searchLink><br /><searchLink fieldCode="DE" term="%22TYPE+2+diabetes%22">TYPE 2 diabetes</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background: There have been several recent advances in the care of patients with chronic kidney disease (CKD), including the use of sodium glucose cotransporter 2 (SGLT2) inhibitors and selective mineralocorticoid receptor antagonists (MRAs). There are very few data reporting the outcomes of these treatments in real-world experience. The aim of this retrospective study is to report the effects of SGLT2 inhibitors, finerenone, and their combination in CKD patients in our community-based setting. Methods: Ninety-eight patients with CKD with an estimated glomerular filtration rate (eGFR) between 25 and 90 mL/min per 1.73 m<superscript>2</superscript> and a urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g were included. Patients were divided into three groups: two monotherapy groups of SGLT2 inhibitors or finerenone and a third combination group of therapy with SGLT2 inhibitors for the first 4 months and SGLT2 inhibitors and finerenone subsequently. The primary outcomes were the timing and percentage of patients achieving a >50% reduction in UACR from baseline. Results: Group 1 comprised 52 patients on SGLT2i, group 2 had 22 patients on finerenone, and group 3 had 24 patients on combination therapy. The baseline median UACR and mean eGFR were 513 mg/g and 47.9 mL/min per 1.73 m<superscript>2</superscript> in group 1, 548.0 mg/g and 50.5 mL/min per 1.73 m<superscript>2</superscript> in group 2, and 800 mg/g and 60 mL/min per 1.73 m<superscript>2</superscript> in group 3. At baseline, 71 (72.4%) patients were on the angiotensin-converting enzyme inhibitor (ACEi) or the angiotensin receptor blocker (ARB), and 78 (79.5%) patients had type 2 diabetes. After 8 months of follow-up, a >50% decrease in albuminuria was achieved in 96% of patients in group 3, compared to 50% in group 1 and 59% in group 2 (p-values were <0.01 and <0.01, respectively). There was a statistically but not clinically significant change in mean potassium levels in group 2 (+0.4 mmol/L) compared to either group 1 (0.0 mmol/L with p-value: <0.01) or group 3 (−0.01 mmol/L with p-value: <0.01). However, there was no difference in potassium levels when comparing groups 1 and 3. At the end of the follow-up, the average difference in eGFR was −3.4 (8.8), −5.3(10.1), and −7.8 (11.2) mL/min per 1.73 m<superscript>2</superscript> in groups 1, 2, and 3, respectively, without a statistically significant difference between groups. Conclusions: In this real-world experience in our community setting, the combination of SGLT2 inhibitors and finerenone in our adult patients with CKD was associated with a very significant and clinically relevant reduction in UACR, without an increased risk of hyperkalemia. Combination therapy of SGLT2 inhibitor and finerenone regarding background use of ACEi/ARB is feasible and should be encouraged for further albuminuria reductions in CKD patients. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of Diagnostics (2075-4418) is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.3390/diagnostics14131357 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 9 StartPage: 1357 Subjects: – SubjectFull: ACE inhibitors Type: general – SubjectFull: ANGIOTENSIN-receptor blockers Type: general – SubjectFull: MINERALOCORTICOID receptors Type: general – SubjectFull: CHRONIC kidney failure Type: general – SubjectFull: TYPE 2 diabetes Type: general Titles: – TitleFull: Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in Chronic Kidney Disease. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Hanouneh, Mohamad – PersonEntity: Name: NameFull: Le, Dustin – PersonEntity: Name: NameFull: Jaar, Bernard G. – PersonEntity: Name: NameFull: Tamargo, Christina – PersonEntity: Name: NameFull: Cervantes, C. Elena IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 07 Text: Jul2024 Type: published Y: 2024 Identifiers: – Type: issn-print Value: 20754418 Numbering: – Type: volume Value: 14 – Type: issue Value: 13 Titles: – TitleFull: Diagnostics (2075-4418) Type: main |
| ResultId | 1 |