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Kerendia is indicated for the treatment of chronic kidney disease (Stages 3 and 4 with albuminuria) associated with type 2 diabetes in adult patients.

Trial Design: FIDELIO-DKD:

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Phase 3, randomised, double-blind, placebo-controlled, multicentre, clinical trial conducted in 48 countries

 Kerendia®▼ finerenone - Trial Design - FIDELIO-DKD Study

Adapted from Bakris

  • patients_icon
    At baseline:
  • 87.5%
    of patients had UACR levels ≥300 mg/g at baseline
  • 99.9%
    of patients received a tolerated dose of an ACEi or ARB
  • 97.4%
    of patients used glucose-lowering medication
  • icon_kidneys-yellow
    The primary renal outcome was the time to the first occurrence of the composite endpoint of:
  • onset of kidney failure†, or
  • a sustained decrease of eGFR ≥ 40% from baseline over at least 4 weeks, or
  • death due to renal causes.
  • icon_heartbeat-gray
    The secondary cardiovascular outcome was the time to first occurrence of the composite endpoint of:
  • CV death, or
  • non-fatal MI, or
  • non-fatal stroke, or
  • hospitalisation for HF

*Includes an ACEi or ARB at the maximum tolerated dose

†Defined as end-stage kidney disease (initiation of dialysis for ≥90 days or kidney transplantation) or an eGFR <15 mL/min/1.73 m2 over ≥4 weeks.

Trial Design

FIDELIO-DKD: Selected inclusion and exclusion criteria

kerendia_trial_design

Adapted from Bakris

 

Trial Design

Patient characteristics were well balanced between groups in the FIDELIO-DKD trial

Key Baseline Characteristics

Kerendia (n=2833)

Placebo (n=2841)

Race (%)

White

62.7

63.9

Black

4.9

4.4

Asian

25.3

25.4

Other

7.0

6.3

Mean age (years)

65.4

65.7

Male (%)

68.9

71.5

Mean eGFR (mL/min/1.73 m²)

44.4

44.3

eGFR distribution (mL/min/1.73 m², %)

54.4

55.4

45 to >60

34.3

32.7

≥60

11.2

11.9

Median UACR (mg/g)

833

867

Mean HbA1c (%)

7.7

7.7

History of cardiovascular disease (%)

46.0

45.8

Trial Design

Patients in both groups were well managed on background therapy for CKD and T2D, respectively

The trial run-in period allowed for background medical therapies to be adjusted, including adjustment of ACEi or ARB therapy to a maximum labelled dose that did not cause unacceptable side effects.

Baseline medications (a)

Kerendia (n=2833)

Placebo (n=2841)

ACEi†

33.5%

34.9%

ARB†

66.3%

65.0%

Alpha-blocking agent

24.5%

25.2%

Beta-blocker

51.6%

53.0%

Calcium antagonist

62.6%

63.8%

Diuretics

55.7%

57.6%

Loop diuretic

27.7%

29.3%

Thiazide diuretic

24.7%

23.1%

Statin

74.3%

74.3%

Platelet aggregation inhibitor (b)

57.6%

56.1%

Potassium-lowering agent (c)

2.5%

2.3%

Glucose-lowering therapies

97.0%

97.7%

Insulin

65.1%

63.1%

Metformin

44.2%

43.6%

Sulphonylurea

23.1%

23.7%

DPP-4 inhibitors

27.0%

26.7%

Alpha-glucosidase inhibitor

5.8%

5.7%

GLP-1 receptor agonists

6.7%

7.2%

SGLT2 inhibitors

4.4%

4.8%

(a)At baseline, 14 patients were not treated with an ACE inhibitor or ARB;

7 patients were treated with both an ACE inhibitor and ARB

(b)Excluding heparins

(c)These agents included sodium polystyrene sulfonate, calcium polystyrene sulfonate, and potassium-binding agents

Trial Design

Planned patient population by KDIGO stratification

Fidelio DKD population
  • blue_icon
    Blue
    low risk (if no other markers of kidney disease, no CKD)
  • yellow_icon
    Yellow
    moderately increased risk
  • orange_icon
    Orange
    high risk
  • red_icon
    Red
    very high risk

Adapted from KDIGO Diabetes Work Group


ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin receptor blocker; CKD=chronic kidney disease; CV=cardiovascular; DKD=diabetic kidney disease; DPP-4=dipeptidyl peptidase-4; eGFR=estimated glomerular filtration rate; GFR=glomerular filtration rate; GLP-1=glucagon-like peptide-1; HbA1c=glycated haemoglobin; HF=heart failure; KDIGO=Kidney Disease: Improving Global Outcomes; MI=myocardial infarction; MOD=mechanism of disease; MOA=mechanism of action; OD=once daily; RAAS=renin-angiotensin-aldosterone system; SGLT2=sodium-glucose cotransporter 2; T2D=type 2 diabetes: UACR=urine albumin-to-creatinine ratio.


PP-KER-GB-0471 | March 2024


    • 1
      UK Kerendia SmPC
    • 2
      Bakris GL, et al; FIDELIO-DKD Investigators. N Engl J Med. 2020;383(23):2219-2229.