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Guidelines recommend albuminuria targets to guide treatment among patients with diabetes. This study examines the degree to which finerenone's beneficial effects on kidney and cardiovascular outcomes can be explained by the drug's effect in reducing early signs of kidney injury as measured by albuminuria. Visual Abstract. Impact of Finerenone-Induced Albuminuria Reduction on Chronic Kidney Disease Outcomes in Type 2 Diabetes: Guidelines recommend albuminuria targets to guide treatment among patients with diabetes. This study examines the degree to which finerenone's beneficial effects on kidney and cardiovascular outcomes can be explained by the drug's effect in reducing early signs of kidney injury as measured by albuminuria. Background: In patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces cardiovascular and kidney failure outcomes. Finerenone also lowers the urine albumin-to-creatinine ratio (UACR). Whether finerenone-induced change in UACR mediates cardiovascular and kidney failure outcomes is unknown. Objective: To quantify the proportion of kidney and cardiovascular risk reductions seen over a 4-year period mediated by a change in kidney injury, as measured by the change in log UACR between baseline and month 4. Design: Post hoc mediation analysis using pooled data from 2 phase 3, double-blind trials of finerenone. (ClinicalTrials.gov: NCT02540993 and NCT02545049) Setting: Several clinical sites in 48 countries. Patients: 12 512 patients with CKD and T2D. Intervention: Finerenone and placebo (1:1). Measurements: Separate mediation analyses were done for the composite kidney (kidney failure, sustained ≥57% decrease in estimated glomerular filtration rate from baseline [approximately a doubling of serum creatinine], or kidney disease death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) outcomes. Results: At baseline, median UACR was 514 mg/g. A 30% or greater reduction in UACR was seen in 3338 (53.2%) patients in the finerenone group and 1684 (27.0%) patients in the placebo group. Reduction in UACR (analyzed as a continuous variable) mediated 84% and 37% of the treatment effect on the kidney and cardiovascular outcomes, respectively. When change in UACR was analyzed as a binary variable (that is, whether the guideline-recommended 30% reduction threshold was met), the proportions mediated for each outcome were 64% and 26%, respectively. Limitation: The current findings are not readily extendable to other drugs. Conclusion: In patients with CKD and T2D, early albuminuria reduction accounted for a large proportion of the treatment effect against CKD progression and a modest proportion of the effect against cardiovascular outcomes. Primary Funding Source: Bayer AG. [ABSTRACT FROM AUTHOR]

The article presents the author's views on a research which finds that N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided management reduces rehospitalization of heart failure (HF) patients. The author observes that adding NT-proBNP-guided management in HF results in significant reduction in mortality, however, it is still unclear whether measurement of NT-proBNP should become a routine part of HF management.

The article presents information on the review of effectiveness of the remote patient monitoring (RPM) for management of patients with heart failures. The studies assessed the effects of RPM in patients with chronic heart failure. Many databases were searched for full-text articles of randomized controlled trials. The study highlighted that RPM reduces mortality and hospitalization for heart failure in comparison to usual care. Also discussion on the result is presented.

The article presents information on the research study conducted to find the frequency and hospitalization after diagnosis of heart failure. 1077 patients with prognostic factors including age, hypertension, body mass index underwent the study. The study found that 83 percent of patients had 1 hospitalization after diagnosis of heart failure and more than half of them were for noncardiovascular causes.

The author reflects on a study, conducted by W.E. Boden and colleagues, which compares the effectiveness of percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) and OMT alone for preventing cardiovascular events in patients with stable coronary artery disease (CAD). He views that the use of drug-eluting stents (DLS) in the study was suboptimal; however, no evidence exists that DLS decrease the incidence of myocardial infarction (MI) compared with bare-metal stents.

The article comments on the study conducted to analyses the efficacy of Candesartan to reduce mortality and hospital admissions in chronic heart failure (CHF). The study extends the knowledge of the role of angiotensin-receptor blocker (ARBs) in patients with CHF. It is likely mat ARBs used at the appropriate dose, such as valsartan 160 mg twice daily or candesartan 32 mg daily, are equivalent to target doses of an ACE inhibitor, such as enalapril 10 mg twice daily. In patients with severe heart failure, an aldosterone blocker might be the preferred agent to add to an ACE inhibitor and a β-blocker rather than an ARB based on the results of a study.

Presents a study that investigated the association of serum digoxin levels with mortality and hospitalization in patients with congestive heart failure and systolic left ventricular dysfunction. Design; Intervention; Outcome measures; Results; Commentary.