{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:41:39Z","timestamp":1792554099232,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"am","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Type 2 diabetes (T2D) and chronic kidney disease (CKD) markedly increase the risk of heart failure (HF) and death. While finerenone improves outcomes in clinical trials, real-world evidence and direct comparisons with steroidal mineralocorticoid receptor antagonists (MRAs) are limited. We evaluated finerenone versus steroidal MRAs (spironolactone and eplerenone) in patients without prior HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX platform, we conducted a retrospective multi-center observational study. We identified patients aged \u226518 years with T2D and CKD without prior HF and ischemic heart disease, who initiated MRAs after receiving a sodium-glucose co-transporter 2 (SGLT2) inhibitor as first-line therapy between 2021 and 2024 (N=3,680). Of these, 724 initiated finerenone and 1,542 initiated a steroidal MRA. After propensity score matching, each group included 551 patients. The primary outcome was all-cause death during the 18-month follow-up period; the secondary outcome was new-onset HF and renal outcome (a composite of end-stage renal disease and dialysis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 18-month, finerenone initiation was associated with lower incidence rates of all-cause death (2.1 vs 4.5 events\/100 person-years; incidence rate difference, \u22122.41; 95% CI, \u22124.38 to \u22120.44) and new-onset HF (6.5 vs 12.9; \u22126.38; 95% CI, \u22129.75 to \u22123.02), whereas no significant difference was observed for the renal outcome (8.3 vs 9.1; \u22120.81; 95% CI, \u22123.99 to 2.37).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Finerenone was associated with a lower 18-month risk of all-cause death compared with steroidal MRAs in patients aged \u226518 years with T2D and CKD without prior HF, who received an SGLT2 inhibitor as first-line therapy; however, residual confounding cannot be excluded, and these findings should be considered hypothesis-generating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag266","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:13:46Z","timestamp":1792552426000},"source":"Crossref","is-referenced-by-count":0,"title":["Finerenone versus Steroidal MRAs in Type 2 Diabetes and Chronic Kidney Disease without Prior Heart Failure"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9639-5470","authenticated-orcid":false,"given":"Takefumi","family":"Kishimori","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8213-7999","authenticated-orcid":false,"given":"Takao","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine , Kyoto ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6300-9112","authenticated-orcid":false,"given":"Takenobu","family":"Shimada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine , Osaka ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Tani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Yamaji","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jumpei","family":"Koike","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takehiro","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Yagi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaharu","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Omi Medical Center , Kusatsu ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,19]]},"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article-pdf\/doi\/10.1093\/eschf\/xvag266\/72162701\/xvag266.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article-pdf\/doi\/10.1093\/eschf\/xvag266\/72162701\/xvag266.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:13:48Z","timestamp":1792552428000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article\/doi\/10.1093\/eschf\/xvag266\/8950375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/eschf\/xvag266","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"article-number":"xvag266"}}