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Peer-reviewedCC BY-NC-NDBMC cardiovascular disorders

Association between finerenone use and risk of new-onset heart failure in chronic kidney disease: a propensity-matched cohort study using the TriNetX network.

  • Jheng-Yan Wu1,2
  • Keng-Wei Lee3
  • Sheng-Chi Huang4
  • Hsuan-Yuan Chang5
  • Yu-Min Lin6
6 affiliations
  1. 1Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.
  2. 2Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  3. 3Division of Cardiology, Department of Internal Medicine, Chi Mei Hospital, Chiali, Tainan, Taiwan.
  4. 4Department of Medical Education, Chi Mei Medical Center, Tainan, Taiwan.
  5. 5Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan (R.O.C.). [email protected].
  6. 6Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan (R.O.C.). [email protected].
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Abstract

Background

Finerenone improves cardiorenal outcomes in chronic kidney disease (CKD) with type 2 diabetes, but its effect on preventing new-onset heart failure (HF) in CKD is uncertain. We evaluated whether finerenone is associated with lower 1-year risk of incident HF and adverse cardiorenal events in CKD patients without prior HF.Methods

In the multi-institutional TriNetX research network, we identified adults with CKD between January 1, 2022, and September 30, 2025. New users of finerenone were compared with finerenone non-users. Propensity score matching (1:1) was performed based on demographics, comorbidities, medications, and key laboratory values. Follow-up began the day after the index date and continued for up to 1 year. The primary outcome was new-onset HF. HF was identified using diagnostic codes and treatment-based criteria; therefore, outcome misclassification cannot be completely excluded. Secondary outcomes were major adverse cardiovascular events (MACE: ischemic stroke, acute myocardial infarction, or death), major adverse kidney events (MAKE), and all-cause mortality. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs).Results

After matching, 11,140 patients were included (mean age 67.5 years, 42.5% female). Finerenone use was associated with a lower 1-year risk of incident HF (4.9% vs. 8.0%; HR 0.68, 95% CI 0.59-0.79; P<.001). Finerenone use was also associated with lower risks of MACE (HR 0.67, 95% CI 0.56-0.81; P<.001), MAKE (HR 0.51, 95% CI 0.39-0.67), and all-cause mortality (HR 0.62, 95% CI 0.47-0.81; P<.001).Conclusions

In this large real-world CKD cohort without prior HF, finerenone use was associated with lower 1-year risks of incident HF, MACE, MAKE, and all-cause mortality compared with non-use. These findings suggest a potential association between finerenone use and a lower observed risk of HF among patients with CKD, although causal relationships cannot be established.

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Cite

BibTeXRIS
BibTeX
@article{wu2026association,
  title = {{Association between finerenone use and risk of new-onset heart failure in chronic kidney disease: a propensity-matched cohort study using the TriNetX network.}},
  author = {Jheng-Yan Wu and Keng-Wei Lee and Sheng-Chi Huang and Hsuan-Yuan Chang and Yu-Min Lin},
  journal = {BMC cardiovascular disorders},
  year = {2026},
  month = aug,
  doi = {10.1186/s12872-026-06384-6},
  url = {https://europepmc.org/article/MED/42958056},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Association between finerenone use and risk of new-onset heart failure in chronic kidney disease: a propensity-matched cohort study using the TriNetX network.
AU  - Jheng-Yan Wu
AU  - Keng-Wei Lee
AU  - Sheng-Chi Huang
AU  - Hsuan-Yuan Chang
AU  - Yu-Min Lin
PY  - 2026
DA  - 2026/08/01
JO  - BMC cardiovascular disorders
DO  - 10.1186/s12872-026-06384-6
UR  - https://europepmc.org/article/MED/42958056
AB  - Background  Finerenone improves cardiorenal outcomes in chronic kidney disease (CKD) with type 2 diabetes, but its effect on preventing new-onset heart failure (HF) in CKD is uncertain. We evaluated whether finerenone is associated with lower 1-year risk of incident HF and adverse cardiorenal events in CKD patients without prior HF.Methods  In the multi-institutional TriNetX research network, we identified adults with CKD between January 1, 2022, and September 30, 2025. New users of finerenone were compared with finerenone non-users. Propensity score matching (1:1) was performed based on demographics, comorbidities, medications, and key laboratory values. Follow-up began the day after the index date and continued for up to 1 year. The primary outcome was new-onset HF. HF was identified using diagnostic codes and treatment-based criteria; therefore, outcome misclassification cannot be completely excluded. Secondary outcomes were major adverse cardiovascular events (MACE: ischemic stroke, acute myocardial infarction, or death), major adverse kidney events (MAKE), and all-cause mortality. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs).Results  After matching, 11,140 patients were included (mean age 67.5 years, 42.5% female). Finerenone use was associated with a lower 1-year risk of incident HF (4.9% vs. 8.0%; HR 0.68, 95% CI 0.59-0.79; P<.001). Finerenone use was also associated with lower risks of MACE (HR 0.67, 95% CI 0.56-0.81; P<.001), MAKE (HR 0.51, 95% CI 0.39-0.67), and all-cause mortality (HR 0.62, 95% CI 0.47-0.81; P<.001).Conclusions  In this large real-world CKD cohort without prior HF, finerenone use was associated with lower 1-year risks of incident HF, MACE, MAKE, and all-cause mortality compared with non-use. These findings suggest a potential association between finerenone use and a lower observed risk of HF among patients with CKD, although causal relationships cannot be established.
SN  - 1471-2261
ER  -