American Journal of Nephrology最新文献

{"title":"Forecasting Urgent Dialysis Needs: From Predictive Accuracy to Clinical Actionability.","authors":"Fariha Shahid Tanveer, Muhammad Hassan Saeed","doi":"10.1159/000551551","DOIUrl":"https://doi.org/10.1159/000551551","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-2"},"PeriodicalIF":3.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Sacubitril/Valsartan vs Irbesartan on Urine Tubular Biomarkers in CKD: Findings from the UK HARP-III Trial.","authors":"Michelle A Goonasekera, Greco B Malijan, Rebecca J Sardell, Natalie Staplin, Benjamin S Storey, Daniel Chapman, Michael Hill, Stewart Moffat, Abdulrahman Al-Mohammad, Doreen Zhu, Nigel J Brunskill, John J V McMurray, Maarten W Taal, William G Herrington, Martin J Landray, Colin Baigent, Richard Haynes, Parminder K Judge","doi":"10.1159/000552348","DOIUrl":"https://doi.org/10.1159/000552348","url":null,"abstract":"<p><strong>Introduction: </strong>Sacubitril/valsartan shows benefits in heart failure and may have kidney protective effects. Its impact on kidney tubular health in chronic kidney disease (CKD) remains unclear. We evaluated the effects of sacubitril/valsartan on urinary markers of tubular dysfunction and injury in UK Heart and Renal Protection-III (HARP III, ISRCTN:11958993).</p><p><strong>Methods: </strong>Urine tubular biomarkers were measured at baseline, 3 and 6 months using first morning void or spot urine samples among 411 participants from UK HARP III. A mixed model repeated measures approach was used to quantify the study average effect of treatment on the urine biomarkers.</p><p><strong>Results: </strong>Compared to allocation to irbesartan, allocation to sacubitril/valsartan reduced neutrophil-gelatinase associated lipocalin (NGAL), a marker secreted in the distal tubules after ischemia and reperfusion, by 18% (95% CI: -32% to -1%). No significant changes were observed for the other biomarkers, and there was no evidence of effect modification by key baseline characteristics across all biomarkers studied.</p><p><strong>Discussion: </strong>In UK HARP-III, sacubitril/valsartan reduced urinary NGAL compared with irbesartan but did not affect other tubular biomarkers of injury, ischemia and fibrosis, suggesting limited tubular benefits, consistent with no observed effect on kidney function.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-9"},"PeriodicalIF":3.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Rurality and Evaluation Start Among Referred Patients with End Stage Kidney Disease.","authors":"Angelitta M Britt-Spells, Jade Buford, Catherine Kelty, Parneet Manjal, Katie Ross-Driscoll, Jonathan A Fridell, Stephen Pastan, Rachel E Patzer, Adam S Wilk","doi":"10.1159/000552281","DOIUrl":"https://doi.org/10.1159/000552281","url":null,"abstract":"<p><strong>Introduction: </strong>Rural residents with end-stage kidney disease have lower access to kidney transplantation, especially in later stages. We examined the impact of rurality on initiation of transplant evaluation and whether this varies by region.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 86,839 adults (18-80 years) referred for kidney transplantation between 2015 and 2023 in the Early Steps to Transplant Access Registry, linked to United States Renal Data System (USRDS). Rurality was defined using the USRDS variable based on ZIP code using Rural-Urban Commuting Area codes. The primary outcome was evaluation initiation within six months of referral. Fine and Gray competing risks models estimated time to evaluation start, accounting for death as a competing event, with multivariable adjustment and interaction by geographic region; sub-analyses were stratified by ESRD Network.</p><p><strong>Results: </strong>Median time to evaluation was longer for rural patients (166 days) than urban patients (106 days), a pattern consistent across all ESRD Networks. The largest rural-urban time gaps were observed in New York and the Ohio River Valley. Rural residence was associated with an 11% lower likelihood of evaluation initiation (aSHR[95% CI], 0.89[0.86,0.92]). The strongest disparities were in New York (aSHR[95% CI], 0.56[0.50,0.62]) and New England (aSHR[95% CI], 0.76[0.69,0.83]). The Southeast (aSHR[95% CI], 0.90[0.87,0.94]) and Ohio River Valley (aSHR[95% CI], 0.92[0.85,0.99]) showed similar associations.</p><p><strong>Conclusions: </strong>Rural residents were less likely to initiate transplant evaluation compared to urban residents. These findings suggest that rural disparities exist in the early steps of the transplant process, highlighting the need for targeted interventions, especially in regions with lowest access.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-17"},"PeriodicalIF":3.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glomerular hyperfiltration as an independent predictor of all-cause mortality in healthy adults: A nationally representative cohort study.","authors":"Lu Zhang, Yiming Zhao, Fucong He, Yanqiu Wang, Baihuan Feng, Shengjun Wu","doi":"10.1159/000552329","DOIUrl":"https://doi.org/10.1159/000552329","url":null,"abstract":"<p><strong>Introduction: </strong>Glomerular hyperfiltration (GHF) is a marker of systemic dysfunction, but its link to long-term mortality in healthy adults remains unclear.</p><p><strong>Methods: </strong>This nationally representative cohort study included 14,309 healthy adults from the National Health and Nutrition Examination Survey. GHF was defined as age- and sex-specific estimated glomerular filtration rate (eGFR) indexed for individual body surface area (BSA) exceeding the 95th percentile. Normal filtration was defined as the 25th-75th percentile. All-cause mortality risk was assessed using Cox proportional hazards models, propensity score matching, and restricted cubic spline regression.</p><p><strong>Results: </strong>Among participants, 722 exhibited GHF (median eGFR: 168 mL/min/BSA m²) and 7,153 had normal filtration (median eGFR: 115 mL/min/BSA m²). Over a median follow-up of 123 months, GHF was associated with increased mortality risk (fully adjusted HR: 1.86; 95% CI: 1.33, 2.60). Propensity score-matched analysis yielded consistent results (HR: 2.60; 95% CI: 1.25, 5.39). Restricted cubic splines revealed a U-shaped eGFR-mortality relationship, with risk progressively increasing above the 60th eGFR percentile. Sensitivity analyses confirmed the robustness of these findings across various stratification methods and exclusion criteria.</p><p><strong>Conclusions: </strong>GHF independently predicts increased mortality in healthy adults, suggesting its potential role as a systemic risk marker and highlighting the potential value of revisiting kidney health assessment frameworks.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-18"},"PeriodicalIF":3.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"Cardiovascular-Kidney-Metabolic\" era in CKD management: Integrated risk factor control and prognostic benefits.","authors":"Zhiqiang Peng, Xiaowei Liang, Licong Su, Ziyang You, Liheng Zhu, Yaya Yang, Yu Wang, Dehui Liu, Min Liang","doi":"10.1159/000552163","DOIUrl":"https://doi.org/10.1159/000552163","url":null,"abstract":"<p><p>Introduction The association between integrated management of metabolic risk factors, as proposed by the Cardiovascular-Kidney-Metabolic syndrome concept, and cardiorenal outcomes in chronic kidney disease (CKD) patients is unclear; therefore, this study aimed to quantify this association, with a focus on specific risk factor combinations. Methods This retrospective cohort study included 42,763 patients with CKD from the China Renal Data System (CRDS). The degree of joint risk factor management was assessed based on 4 metabolic risk factors, namely, blood pressure, glucose, low-density lipoprotein cholesterol and body mass index (BMI). The association between cardiorenal outcomes and the degree of risk factor control or specific risk combinations was assessed using Cox proportional hazards models up to 64,699.25 person-years of follow-up. Results In CKD patients, the degree of risk factor management demonstrated a dose-dependent association with lower risks of cardiovascular disease (CVD) events and CKD progression. Patients achieving management of all risk factors had significantly reduced HRs for CVD (0.69; 95% CI: 0.61-0.79) and CKD progression (0.79; 95%CI:0.69-0.89) versus those with no management. The most protective combinations were blood pressure, glucose, and BMI management for CVD events (HR: 0.66; 95% CI: 0.57-0.77) and CKD progression (HR: 0.78; 95% CI: 0.69-0.89). Conclusions In this large CKD cohort, achieving simultaneous control of blood pressure, glucose, and BMI was associated with the greatest reduction in both cardiovascular and kidney outcomes, supporting integrated multi-target management within the CKM syndrome framework.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-16"},"PeriodicalIF":3.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Advances and Future Directions in the Mechanisms and Therapeutic Strategies Targeting the Complement System in Diabetic Nephropathy.","authors":"Qiang Niu, Keyi Zhou, Tao Zhang","doi":"10.1159/000551634","DOIUrl":"https://doi.org/10.1159/000551634","url":null,"abstract":"<p><p>Diabetic nephropathy (DN) is a common and life-threatening complication in diabetic patients, with a complex pathogenesis. Increasing evidence indicates that the complement system plays a pivotal role in the pathogenesis of DN. Accordingly, this review highlights the altered expression and deposition of complement components in DN patients and assesses their potential as diagnostic biomarkers. Furthermore, the mechanisms driving complement pathway activation and the complement-mediated mechanisms of renal injury are both explored. Additionally, we summarize the existing phenotypes of complement inhibitors utilized in both preclinical and clinical studies, emphasizing their potential value in DN treatment. The in-depth analysis of the relationship between the complement system and diabetic nephropathy in this review will provide new insights for the prevention and treatment of diabetic nephropathy.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-19"},"PeriodicalIF":3.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Risk of Acute Kidney Injury in Hospitalized Patients Treated With SGLT-2 Inhibitors: A Retrospective Matched Cohort Study.","authors":"Dion Gabriël Lodewijk de Martines, Kenan Hasan Ali Aydinoglu, Christina Gant, Ytzen Westra, Kim de Jong, Aaltje Ymkje Adema","doi":"10.1159/000551925","DOIUrl":"https://doi.org/10.1159/000551925","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have shown possible protective effects of sodium-glucose co-transporter-2 inhibitors (SGLT-2i) for acute kidney injury (AKI). As SGLT-2i have diuretic properties, uncertainty remains regarding their effect on the risk of AKI during hospital admission, where hypovolemia frequently occurs. Therefore, we assessed the association between (pre)hospital treatment with SGLT-2i and AKI risk in hospitalized patients.</p><p><strong>Methods: </strong>We performed a matched cohort study. We identified hospitalized patients with prehospital use of SGLT-2i in the Frisius Medical Centre Leeuwarden, between October 21, 2021, and February 12, 2024. These were matched 1:1 to hospitalized patients without prehospital use of SGLT-2i. AKI incidence was the main outcome. Secondly, SGLT-2i treatment during hospitalization was assessed.</p><p><strong>Results: </strong>1054 hospital admissions were included, 527 with and 527 without prehospital SGLT-2i use. 34% of patients were women, the median age was 71 years (IQR 65-78). SGLT-2i was indicated for heart failure in 16%, chronic kidney disease 6%, type 2 diabetes 7%, and at least two indications in 72%. Hospital-acquired AKIs occurred in 17.5% admissions with prehospital SGLT-2i treatment and 25.8% among those without (RR = 0.68 (95%CI = 0.53 to 0.86)). AKI risk was similarly decreased in patients continuing SGLT-2i during hospital admission (RR 0.65 (0.49 - 0.85)). AKI was associated with increased length of hospital stay (median 7 days, IQR 4-11, versus 3 days, IQR 1-7 without AKI), SGLT-2i use was not. Overall, SGLT-2i treatment did not affect overall mortality. In patients with AKI, mortality was numerically lower in SGLT-2i patients (Risk Difference = 7.8%, 95% CI -0.9 to 15.7%), although the confidence interval includes zero.</p><p><strong>Conclusion: </strong>We observed a 32% lower risk of AKI in hospitalized patients using SGLT-2i at admission. This suggest a protective effect of SGLT-2i against AKI, which remained when SGLT-2i was continued during hospitalization.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-23"},"PeriodicalIF":3.2,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mineralocorticoid Receptor Antagonists in Dialysis.","authors":"Elias John Elenjickal, Thomas A Mavrakanas","doi":"10.1159/000551881","DOIUrl":"https://doi.org/10.1159/000551881","url":null,"abstract":"<p><strong>Background: </strong>Aldosterone regulates genes controlling fluid and electrolyte balance through mineralocorticoid receptor (MR) activation. Sustained MR activation promotes inflammation, fibrosis, sodium retention, and myocardial remodeling. MR antagonists (MRAs) block aldosterone binding in the kidney, heart, and vasculature and are classified as steroidal or nonsteroidal. Although large, randomized trials have confirmed the benefits of steroidal MRAs in heart failure and of finerenone in diabetic kidney disease, these pivotal studies systematically excluded patients with kidney failure receiving dialysis. Over the past decade, several Phase 2 and 3 trials have evaluated MRAs in dialysis, yielding heterogeneous and sometimes conflicting results. This review summarizes the biological rationale, evolving clinical evidence, and future directions for MR blockade in dialysis.</p><p><strong>Summary: </strong>Pharmacokinetic studies indicate that spironolactone and eplerenone are highly protein-bound, hepatically metabolized, and not dialyzable, supporting cautious use in dialysis with potassium monitoring. Early randomized trials from East Asia suggested potential cardiovascular benefit with spironolactone 25 mg daily; however, these studies were underpowered and reported relatively few outcome events. More definitive evidence is now available from two large multicenter randomized controlled trials. In ALCHEMIST (n = 644), spironolactone 25 mg daily did not reduce major adverse cardiovascular events compared with placebo over a median follow-up of 2.7 years [Hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.73-1.36]. Similarly, in ACHIEVE (n = 2,538), spironolactone failed to reduce the composite of cardiovascular death or hospitalization for heart failure (HR 0.92, 95% CI 0.78-1.09) over 1.8 years and was associated with higher rates of hyperkalemia. A contemporary meta-analysis incorporating these trials confirmed neutral efficacy but higher rates of asymptomatic hyperkalemia and gynecomastia.</p><p><strong>Key messages: </strong>Current evidence indicates that steroidal MRAs confer no cardiovascular or survival benefit in maintenance dialysis and modestly increase the risk of hyperkalemia and endocrine adverse effects.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-27"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially modifiable factors associated with longitudinal health-related quality of life in the National Unified Renal Translational Research Enterprise CKD (NURTuRE-CKD) cohort.","authors":"Thomas Phillips, Scott Harris, Olalekan Lee Aiyegbusi, Melissa Benavente, Paul Cockwell, Philip A Kalra, Paul J Roderick, David C Wheeler, Maarten W Taal, Simon D S Fraser","doi":"10.1159/000551177","DOIUrl":"https://doi.org/10.1159/000551177","url":null,"abstract":"<p><p>Introduction People with non-dialysis-dependent chronic kidney disease (NDD-CKD) experience worse health-related quality of life (HRQoL) than those without. This study hypothesised that potentially modifiable factors affecting longitudinal HRQoL in a NDD-CKD cohort could be identified in order to identify potential therapeutic targets for improving HRQoL outcomes. Methods The NURTuRE-CKD cohort study recruited 2996 participants with NDD-CKD from UK nephrology centres from 2017. Sociodemographic, medical history, medication, anthropometric, biomarker and patient-reported outcome measure (PROM) data were collected at baseline and first follow-up. HRQoL was measured at second follow-up. The primary outcome was HRQoL measured by EQ-5D-5L, mapped to EQ-5D-3L index value and visual analogue score (VAS). Multivariable mixed effects linear regression models were adjusted and fit to examine the effect of potentially modifiable factors at baseline on longitudinal EQ-5D-3L index value. Similar models were also fit to assess the effects of change in these factors across follow-up on index value and VAS. Results 2062 participants (68.8%) attended first and 1019 (34.0%) second follow-up. EQ-5D-5L responses worsened over time for index value, VAS and in each dimension. Baseline factors independently associated with worse longitudinal HRQoL were obesity, smoking, sarcopenia, pain, breathlessness, weakness, anxiety, depression and raised parathyroid hormone (PTH), whereas renin-angiotensin-system inhibitor use at baseline was associated with improved HRQoL. The status of factors across follow-up such as persistent obesity, new sarcopenia, increasing phosphate, new and persistent anxiety and depression, and worsening pain were associated with worse HRQoL, whereas improved acidosis, improved pain and weakness were associated with improved HRQoL. Conclusion Several potentially modifiable factors independently associated with HRQoL, and NDD-CKD interventions should consider these as therapeutic targets, as well as part of holistic CKD care.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-29"},"PeriodicalIF":3.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of finerenone treatment discontinuation on kidney and cardiovascular outcomes: a FIDELITY analysis.","authors":"Ajay K Singh, Stefan D Anker, Bertram Pitt, Peter Rossing, Luis M Ruilope, Christiane Ahlers, Youssef M K Farag, Marc Lambelet, Meike Brinker, Katja Rohwedder, Zihe Zheng, Gerasimos Filippatos","doi":"10.1159/000549873","DOIUrl":"https://doi.org/10.1159/000549873","url":null,"abstract":"<p><p>Introduction Finerenone reduced the risk of heart and kidney events in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in FIDELITY, a prespecified pooled analysis combining data from the phase III FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049) trials. This FIDELITY analysis aimed to identify and assess key predictors of finerenone discontinuation and evaluate the impact of discontinuation on its efficacy in people with CKD and T2D. Methods Adults with CKD (urine albumin-to-creatinine ratio 30-≤5000 mg/g, estimated glomerular filtration rate [eGFR] ≥25 mL/min/1.73 m2) and T2D on optimized renin-angiotensin system inhibition were randomized 1:1 to finerenone or placebo. Baseline characteristics were identified and assessed as predictors of treatment discontinuation using a multivariate Cox proportional hazards model. Stratified Cox models with treatment discontinuation as a time-varying covariate were used to assess the effect of treatment discontinuation on composite kidney and cardiovascular (CV) outcomes (kidney: kidney failure, sustained ≥57% eGFR decrease from baseline over ≥4 weeks, or kidney-related death; CV: CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure). Results Among 12,990 participants included in the analysis, 22.8% and 21.6% prematurely discontinued treatment in the finerenone and placebo arms, respectively. Advanced age, White/Black race, lower eGFR, higher urine albumin-to-creatinine ratio, and higher serum potassium at baseline were identified as predictors of finerenone discontinuation. Crude event rates per 100 patient-years for the composite kidney and CV outcomes were lower with finerenone versus placebo under treatment (kidney: 1.09 vs 1.71; CV: 2.98 vs 3.78) as well as after discontinuation (kidney: 11.95 vs 13.67; CV: 14.07 vs 14.73). The effect of finerenone on composite kidney and CV outcomes appeared to be reduced after discontinuation (hazard ratio [HR]=0.82; 95% confidence interval [CI] 0.66-1.02; HR=0.93; 95% CI 0.79-1.09, respectively) versus the time on-treatment (HR=0.65; 95% CI 0.54-0.78; pinteraction=0.0959; HR=0.79; 95% CI 0.70-0.88; pinteraction=0.0960, respectively). Conclusion In FIDELITY, treatment discontinuation rates were similar in the finerenone and placebo arms. Finerenone demonstrated numerically higher kidney and CV benefits during treatment versus after discontinuation.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-20"},"PeriodicalIF":3.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}