#2198 Effect of finerenone on eGFR slope across different levels of baseline albuminuria: insights from FINEARTS-HF

Abstract Background and Aims Finerenone did not modify the risk of kidney outcomes or eGFR decline among patients with heart failure (HF) in the FINEARTS-HF trial, who were generally at low risk for kidney disease progression. However, whether the effect of finerenone on eGFR slope differs according to baseline urine albumin:creatinine ratio (UACR) is not clear. Method FINEARTS-HF was a global, randomized clinical trial of finerenone vs. placebo among patients with HF with mildly reduced or preserved ejection fraction (N = 6,001). In this post-hoc analysis, we used mixed models repeated measures approaches to explore treatment effects on changes in eGFR slope from baseline to month 3, (acute slope), month 3 to end of follow-up (chronic slope), and baseline to end of follow-up (total slope) according to categories of baseline UACR (<30, 30–<300, ≥300 mg/g). Results Among 5,797 participants with available data, the mean baseline eGFR was 62 ± 20mL/min/1.73 m2 and median UACR was 18 [7, 67] mg/g (UACR <30mg/g: 61%; 30–<300mg/g: 30%; and ≥300mg/g: 10%). Finerenone caused a greater initial decline in eGFR (acute slope) than placebo across all categories of UACR (P-interaction = 0.26). Although there was no clear heterogeneity of treatment effects (P-interaction = 0.09), finerenone appeared to lead to a slower decline in chronic eGFR slope than placebo among those with UACR ≥300 mg/g (difference 1.2; 95% CI 0.1, 2.2 mL/min/1.73 m2/year). Conclusion Among patients with HF and macroalbuminuria (at higher risk of kidney disease progression), finerenone slowed the decline in chronic eGFR slope to a clinically relevant greater extent than placebo.