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NEJM:Finerenone对肾脏疾病和2型糖尿病患者心血管事件的影响

2021-12-09 MedSci原创 MedSci原创

Finerenone是一种选择性非甾体盐皮质激素受体拮抗剂,对伴有严重白蛋白尿和2型糖尿病的3或4期慢性肾病(CKD)患者心肾结局具有良好的效应。Finerenone在2型糖尿病和更广泛的CKD患者中

Finerenone是一种选择性非甾体盐皮质激素受体拮抗剂,对伴有严重白蛋白尿和2型糖尿病的3或4期慢性肾病(CKD)患者心肾结局具有良好的效应。Finerenone在2型糖尿病和更广泛的CKD患者中的使用尚未明确。

近日,顶级医学期刊NEJM上发表了一篇研究文章,在这项双盲试验中,研究人员将CKD和2型糖尿病患者随机分配接受Finerenone或安慰剂治疗。符合条件的患者的尿白蛋白与肌酐比(白蛋白以mg为单位,肌酐以g为单位)为30至300,估计的肾小球滤过率(eGFR)为25至90ml/min/1.73m2(2至4期CKD)或尿白蛋白/肌酐比为300至5000,eGFR至少为60ml/min/1.73m2(1期或2期CKD)。

在事件时间分析中评估的主要结局是心血管原因死亡、非致死性心肌梗死、非致死性卒中或因心力衰竭住院的复合结局。第一个次要结局是肾功能衰竭、eGFR比基线持续降低至少40%或肾脏原因死亡的复合结局。安全性评估为研究者报告的不良事件。

该研究共有7437名患者接受了随机化分组。在纳入分析的患者中,在3.4年的中位随访期间,Finerenone组3686名患者中有458名(12.4%)发生主要结局事件,安慰剂组3666名患者中有519名(14.2%)发生主要结局事件(风险比为0.87;95%置信区间[CI]为0.76至0.98;P=0.03),主要是由较低的心力衰竭住院发生率所驱动(风险比为0.71;95%CI为0.56至0.90)。Finerenone组350名患者(9.5%)和安慰剂组395名患者(10.8%)发生次要复合结局(风险比为0.87;95%CI为0.76至1.01)。不良事件的总体频率在各组之间没有显著差异。Finerenone组(1.2%)因高钾血症终止试验方案的发生率高于安慰剂组(0.4%)。

由此可见,在白蛋白尿中度升高的2型糖尿病和2至4期CKD或蛋白尿严重升高的1或2期CKD患者中,与安慰剂相比,Finerenone治疗改善了心血管结局。

原始出处:
 
Bertram Pitt,et al.Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes.NEJM.2021.https://www.nejm.org/doi/full/10.1056/NEJMoa2110956

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    2021-12-09 不忘初心。

    很好!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1643778, encodeId=806a1643e78e1, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Mon Sep 19 17:08:17 CST 2022, time=2022-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968157, encodeId=a65f196815e48, content=<a href='/topic/show?id=e9a9e45455' target=_blank style='color:#2F92EE;'>#Finerenone#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7454, encryptionId=e9a9e45455, topicName=Finerenone)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afa4194, createdName=cenghis, createdTime=Wed Dec 29 18:08:17 CST 2021, time=2021-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383745, encodeId=02f11383e45d0, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Sat Dec 11 00:08:17 CST 2021, time=2021-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475189, encodeId=eb1814e518977, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Dec 11 00:08:17 CST 2021, time=2021-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1078370, encodeId=a07010e83708b, content=很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/02/13/9f876eee41ba0f0adc010e92cf82ced1.jpg, createdBy=b0ce2545971, createdName=不忘初心。, createdTime=Thu Dec 09 10:06:36 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1078350, encodeId=452b10e835088, content=Finerenone是一种选择性非甾体盐皮质激素受, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Thu Dec 09 09:32:14 CST 2021, time=2021-12-09, status=1, ipAttribution=)]
    2021-12-09 查查佳佳

    Finerenone是一种选择性非甾体盐皮质激素受

    0

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