{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:29:22Z","timestamp":1793395762632,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004326","name":"Bayer AG","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004326","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mineralocorticoid receptor antagonists (MRAs) reduce systolic blood pressure (SBP) and increase serum potassium concentration ([K+]). This indirect comparison investigated any differences in SBP-lowering and hyperkalemia risk between finerenone, a nonsteroidal MRA, and the steroidal MRA spironolactone\u00a0\u00b1\u00a0a potassium binder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In FIDELITY (a pooled analysis of FIDELIO-DKD and FIGARO-DKD), a subgroup of patients with treatment-resistant hypertension (TRH) and chronic kidney disease meeting eligibility criteria of the AMBER trial were identified (FIDELITY-TRH). The main outcomes were mean change in SBP, incidence of serum [K+] \u22655.5\u00a0mmol\/L and hyperkalemia-associated treatment discontinuation. Results at \u223c17\u00a0weeks were compared with 12\u00a0weeks from AMBER.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 624 FIDELITY-TRH patients and 295 AMBER patients, the least squares mean change in SBP (mmHg) from baseline was \u22127.1 for finerenone and \u22121.3 for placebo {between-group difference \u22125.74 [95% confidence interval (CI) \u22127.99 to \u22123.49], P\u00a0&amp;lt;\u00a0.0001} versus \u221211.7 for spironolactone\u00a0+\u00a0patiromer and \u221210.8 for spironolactone\u00a0+\u00a0placebo [between-group difference \u22121.0 (95% CI \u22124.4\u20132.4), P\u00a0=\u00a0.58]. The incidence of serum [K+] \u22655.5\u00a0mmol\/L was 12% for finerenone and 3% for placebo versus 35% with spironolactone\u00a0+\u00a0patiromer and 64% with spironolactone\u00a0+\u00a0placebo. Treatment discontinuation due to hyperkalemia was 0.3% for finerenone and 0% for placebo versus 7% for spironolactone\u00a0+\u00a0patiromer and 23% for spironolactone\u00a0+\u00a0placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with TRH and chronic kidney disease compared with spironolactone with or without patiromer, finerenone was associated with a lower SBP reduction and lower risk of hyperkalemia and treatment discontinuation.<\/jats:p>\n                    <jats:p>Trial Registration: AMBER (NCT03071263), FIDELIO-DKD (NCT02540993), FIGARO-DKD (NCT02545049)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfac234","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T08:51:32Z","timestamp":1666687892000},"page":"293-302","source":"Crossref","is-referenced-by-count":120,"title":["A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease"],"prefix":"10.1093","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8355-7100","authenticated-orcid":false,"given":"Rajiv","family":"Agarwal","sequence":"first","affiliation":[{"name":"Richard L. Roudebush VA Medical Center and Indiana University , Indianapolis, IN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Michigan School of Medicine , Ann Arbor, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biff F","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8204-911X","authenticated-orcid":false,"given":"Csaba P","family":"Kovesdy","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Tennessee, Health Science Center Memphis , TN , USA"},{"name":"Nephrology Section, Memphis VA Medical Center , Memphis, TN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Burgess","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary , Calgary, AB , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital , Athens , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Ma\u0142yszko","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw , Warsaw , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M","family":"Ruilope","sequence":"additional","affiliation":[{"name":"Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12 , Madrid , Spain"},{"name":"CIBER-CV, Hospital Universitario 12 de Octubre , Madrid , Spain"},{"name":"Faculty of Sport Sciences, European University of Madrid , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4470-7932","authenticated-orcid":false,"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d\u2019Investigations Cliniques \u2013 Plurith\u00e9matique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-4294","authenticated-orcid":false,"given":"Peter","family":"Rossing","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Copenhagen , Herlev , Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Pecoits-Filho","sequence":"additional","affiliation":[{"name":"Arbor Research Collaborative for Health , Ann Arbor, MI , USA"},{"name":"School of Medicine, Pontificia Universidade Cat\u00f3lica do Paran\u00e1 , Curitiba , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies , German Centre for Cardiovascular Research Partner Site Berlin, Charit\u00e9 Universit\u00e4tsmedizin, Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer","family":"Joseph","sequence":"additional","affiliation":[{"name":"Cardiology and Nephrology Clinical Development , Bayer AG, Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Lawatscheck","sequence":"additional","affiliation":[{"name":"Cardiology and Nephrology Clinical Development , Bayer AG, Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Wilson","sequence":"additional","affiliation":[{"name":"US Medical Affairs, Bayer US LLC Pharmaceuticals , Whippany, NJ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0812-8490","authenticated-orcid":false,"given":"Martin","family":"Gebel","sequence":"additional","affiliation":[{"name":"Research and Development, Integrated Analysis Statistics , Bayer AG, Wuppertal , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George L","family":"Bakris","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Chicago Medicine , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,30]]},"reference":[{"key":"2023070410540183900_bib1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1053\/j.ajkd.2018.12.044","article-title":"Hypertension in CKD: core curriculum 2019","volume":"74","author":"Ku","year":"2019","journal-title":"Am J Kidney Dis"},{"key":"2023070410540183900_bib2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1053\/j.ackd.2010.10.003","article-title":"Hypertension in diabetic nephropathy: epidemiology, mechanisms, and management","volume":"18","author":"Van Buren","year":"2011","journal-title":"Adv Chronic Kidney Dis"},{"key":"2023070410540183900_bib3","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1016\/S0140-6736(15)00257-3","article-title":"Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial","volume":"386","author":"Williams","year":"2015","journal-title":"Lancet"},{"key":"2023070410540183900_bib4","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.jash.2008.05.005","article-title":"Effectiveness of the selective aldosterone blocker, eplerenone, in patients with resistant hypertension","volume":"2","author":"Calhoun","year":"2008","journal-title":"J Am Soc Hypertens"},{"key":"2023070410540183900_bib5","first-page":"S1","article-title":"KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease","volume":"99(3 Suppl)","author":"Kidney Disease: Improving Global Outcomes","year":"2021","journal-title":"Kidney Int"},{"key":"2023070410540183900_bib6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jchf.2018.10.017","article-title":"Efficacy and safety of spironolactone in patients with HFpEF and chronic kidney disease","volume":"7","author":"Beldhuis","year":"2019","journal-title":"JACC Heart Fail"},{"key":"2023070410540183900_bib7","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH guidelines for the management of arterial hypertension","volume":"39","author":"Williams","year":"2018","journal-title":"Eur Heart J"},{"key":"2023070410540183900_bib8","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1097\/HJH.0000000000002453","article-title":"2020 International Society of Hypertension global hypertension practice guidelines","volume":"38","author":"Unger","year":"2020","journal-title":"J Hypertens"},{"key":"2023070410540183900_bib9","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1016\/S0140-6736(19)32135-X","article-title":"Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial","volume":"394","author":"Agarwal","year":"2019","journal-title":"Lancet"},{"key":"2023070410540183900_bib10","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1093\/eurheartj\/ehab777","article-title":"Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis","volume":"43","author":"Agarwal","year":"2022","journal-title":"Eur Heart J"},{"key":"2023070410540183900_bib11","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1159\/000503713","article-title":"Design and baseline characteristics of the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic kidney Disease trial","volume":"50","author":"Bakris","year":"2019","journal-title":"Am J Nephrol"},{"key":"2023070410540183900_bib12","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1159\/000503712","article-title":"Design and baseline characteristics of the Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease trial","volume":"50","author":"Ruilope","year":"2019","journal-title":"Am J Nephrol"},{"key":"2023070410540183900_bib13","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1056\/NEJMoa2025845","article-title":"Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes","volume":"383","author":"Bakris","year":"2020","journal-title":"N Engl J Med"},{"key":"2023070410540183900_bib14","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1056\/NEJMoa2110956","article-title":"Cardiovascular events with finerenone in kidney disease and type 2 diabetes","volume":"385","author":"Pitt","year":"2021","journal-title":"N Engl J Med"},{"key":"2023070410540183900_bib15","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1159\/000492622","article-title":"Patiromer to enable spironolactone use in the treatment of patients with resistant hypertension and chronic kidney disease: rationale and design of the AMBER study","volume":"48","author":"Agarwal","year":"2018","journal-title":"Am J Nephrol"},{"key":"2023070410540183900_bib16"},{"key":"2023070410540183900_bib17","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1053\/j.ajkd.2020.04.017","article-title":"Resistant hypertension in people with CKD: a review","volume":"77","author":"Fay","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"2023070410540183900_bib18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1093\/eurheartj\/ehaa736","article-title":"Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine","volume":"42","author":"Agarwal","year":"2021","journal-title":"Eur Heart J"},{"key":"2023070410540183900_bib19","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/164_2016_76","article-title":"Steroidal and novel non-steroidal mineralocorticoid receptor antagonists in heart failure and cardiorenal diseases: comparison at bench and bedside","volume":"243","author":"Kolkhof","year":"2017","journal-title":"Handb Exp Pharmacol"},{"key":"2023070410540183900_bib20","first-page":"CD007004","article-title":"Aldosterone antagonists for preventing the progression of chronic kidney disease","volume":"4","author":"Bolignano","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2023070410540183900_bib21","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jacc.2021.05.002","article-title":"Kidney function and outcomes in patients hospitalized with heart failure","volume":"78","author":"Patel","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2023070410540183900_bib22","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1093\/eurheartj\/eht187","article-title":"Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial","volume":"34","author":"Pitt","year":"2013","journal-title":"Eur Heart J"},{"key":"2023070410540183900_bib23","doi-asserted-by":"crossref","first-page":"e13413","DOI":"10.1111\/ijcp.13413","article-title":"Efficacy and safety of mineralocorticoid receptor antagonists with ACEI\/ARB treatment for diabetic nephropathy: a meta-analysis","volume":"73","author":"Zuo","year":"2019","journal-title":"Int J Clin Pract"},{"key":"2023070410540183900_bib24","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1681\/ASN.2021070942","article-title":"Hyperkalemia risk with finerenone: results from the FIDELIO-DKD trial","volume":"33","author":"Agarwal","year":"2022","journal-title":"J Am Soc Nephrol"},{"key":"2023070410540183900_bib25","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1056\/NEJMoa1303154","article-title":"Combined angiotensin inhibition for the treatment of diabetic nephropathy","volume":"369","author":"Fried","year":"2013","journal-title":"N Engl J Med"},{"key":"2023070410540183900_bib26","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1159\/000476004","article-title":"Modification of potassium-mortality relationship by ethnicity and race: solving the puzzle","volume":"45","author":"Agarwal","year":"2017","journal-title":"Am J Nephrol"},{"key":"2023070410540183900_bib27","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1093\/eurheartj\/ehy100","article-title":"Serum potassium and adverse outcomes across the range of kidney function: a CKD prognosis consortium meta-analysis","volume":"39","author":"Kovesdy","year":"2018","journal-title":"Eur Heart J"},{"key":"2023070410540183900_bib28","doi-asserted-by":"crossref","first-page":"181","DOI":"10.2298\/MPNS1406181M","article-title":"Severe hyperkalemia induced by propranolol","volume":"67","author":"Mandi\u0107","year":"2014","journal-title":"Med Pregl"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfac234\/47161723\/sfac234.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/16\/2\/293\/50795753\/sfac234.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/16\/2\/293\/50795753\/sfac234.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T09:16:48Z","timestamp":1688462208000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/16\/2\/293\/6780216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,30]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,10,30]]},"published-print":{"date-parts":[[2023,2,6]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfac234","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2]]},"published":{"date-parts":[[2022,10,30]]}}}