Sexual dimorphism and age effects in CKD and type 2 diabetes in the CONFIDENCE trial

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Abstract
Introduction: Concurrent initiation of finerenone and empagliflozin can lower albuminuria more than component therapies at Day 180 in participants with chronic kidney disease (CKD) and type 2 diabetes (T2D ). We evaluated baseline clinical characteristics and longitudinal changes in urinary albumin-to-creatinine ratio (UACR) across age and sex cohorts. Methods: In CONFIDENCE (NCT05254002), participants with T2D, CKD (estimated glomerular filtration rate [eGFR] 30–90 ml/min/1.73 m2), and albuminuria (UACR 100 to 74 years) and sex. Outcomes included % change in UACR from baseline over time and incidences of key adverse events. Results: Increasing age was associated with higher baseline prevalence of atherosclerotic cardiovascular disease and lower eGFR. Older age was a significant predictor of UACR reduction, with –10.2% (95% CI: –15.5, –4.6) incremental change per 10-year age increase at Day 180 (P for age effect = 0.001). Women exhibited an 18.6% (95% CI: 6.3, 29.2) greater UACR reduction at Day 180 than men (P for sex effect = 0.008). These effects were independent of treatment; there was no interaction between age (P-interaction = 0.28) or sex (P-interaction = 0.46) on combination therapy treatment effect. Safety outcomes were consistent across all demographics. Conclusions: The UACR-lowering response of finerenone and empagliflozin scaled linearly with age (10% per decade) and sex (∼20% more among women). The benefit of combination therapy was independent of age and sex.
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  • Bayer

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