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040			_aBMG
041			_aeng
100			_aHeerspink, Hiddo J. L. _eAutor _954043
245			_aFinerenone in persons with chronic kidney disease without diabetes
300			_apáginas: 533-545
520			_aBackground: In randomized trials, finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improved kidney and cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease (CKD). Whether finerenone has similar effects in patients without diabetes who have CKD is unknown. Methods: We randomly assigned adults without diabetes who had CKD (estimated glomerular filtration rate [eGFR], 25 to <90 ml per minute per 1.73 m2 of body-surface area) and albuminuria (urinary albumin-to-creatinine ratio, 200 to ≤3500, with albumin in milligrams and creatinine in grams) and were using a renin–angiotensin system inhibitor to receive finerenone (10 or 20 mg daily) or placebo. The primary outcome was the total eGFR slope (mean annual rate of change in the eGFR from baseline to month 32), assessed with a two-slope linear spline mixed-effects model. Secondary outcomes included a composite of kidney or cardiovascular events (reduction from baseline of at least 57% in the eGFR, kidney failure, hospitalization for heart failure, or death from cardiovascular causes), a composite of the two kidney events, and a composite of the two cardiovascular events. Results: A total of 1584 participants underwent randomization — 793 were assigned to the finerenone group, and 791 to the placebo group. The mean (±SD) baseline eGFR was 46.8±16.2 ml per minute per 1.73 m2 with finerenone and 46.6±16.0 ml per minute per 1.73 m2 with placebo. The mean annual rate of change in the eGFR from baseline to month 32 was −3.3 ml per minute per 1.73 m2 (95% confidence interval [CI], −3.6 to −3.1) with finerenone and −4.0 ml per minute per 1.73 m2 (95% CI, −4.3 to −3.8) with placebo (difference, 0.7; 95% CI, 0.3 to 1.1; P<0.001). Prespecified hierarchical testing showed that the risk of a composite kidney or cardiovascular outcome event was lower with finerenone than with placebo (hazard ratio, 0.77; 95% CI, 0.60 to 0.99; P=0.04); the hazard ratio was 0.78 (95% CI, 0.60 to 1.01) for the composite of the two kidney events and 0.60 (95% CI, 0.27 to 1.33) for the composite of the two cardiovascular events. The most common adverse event was hyperkalemia (135 participants [17.0%] with finerenone and 105 [13.3%] with placebo); hyperkalemia events led to discontinuation of the trial regimen in 12 participants (1.5%) and 1 participant (0.1%), respectively, and to hospitalization in 7 (0.9%) and 5 (0.6%). Conclusions: Among adults with CKD who did not have diabetes, finerenone led to a slower decrease in the eGFR than placebo over 32 months.
650			_aCARDIOLOGÍA GENERAL _953638
650			_aENFERMEDAD RENAL CRÓNICA _932213
650			_aMEDICINA CLÍNICA GENERAL _953666
650			_aNEFROLOGÍA GENERAL _953655
700			_aNeuen, Brendon L. _954044
700			_aAgarwal, Rajiv _954045
700			_aCherney, David Z.I. _954046
700			_aLam, Carolyn S.P. _954047
700			_aTuttle, Katherine R. _954048
700			_aWanner, Christoph _945757
700			_aSarafidis, Pantelis _954049
700			_aJongs, Niels _954050
700			_aSmeijer, J. David _954051
700			_aBrinker, Meike _954052
773	0		_022717 _922644 _dMassachusetts NEJM Group _oNEJM009 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-08-14 _zSQB
999			_c22812 _d22812