AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Kidney Failure Risk Equation, Clinical Outcomes, and Effect of Finerenone in HFmrEF/HFpEF: Insights from FINEARTS-HF
By Ono R, Docherty K, Henderson AD et al.
Background: The Kidney Failure Risk Equation (KFRE) is recommended in international guidelines for estimating the risk of kidney failure in patients with chronic kidney disease (CKD). The prognostic relevance of the KFRE has not been described in patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Hypothesis: Higher KFRE scores are associated with an increased risk of both kidney and cardiovascular (CV) outcomes in patients with HFmrEF/HFpEF and CKD. Methods: FINEARTS-HF investigated the efficacy and safety of finerenone compared with placebo in patients with HF and left ventricular EF ≥40%. The KFRE incorporates urine albumin-creatinine ratio, age, sex, and estimated glomerular filtration rate (eGFR). We evaluated the association between KFRE score at baseline and kidney and CV outcomes among FINEARTS-HF patients with an eGFR <60 mL/min/1.73m ² at baseline. The prespecified primary outcome of the trial was total (first and recurrent) HF events and CV death; we also examined this composite in a time-to-first event analysis. The prespecified kidney outcome was the composite of sustained ≥50% decline in eGFR, sustained decline in eGFR to <15 ml/min/1.73 m ² , initiation of chronic dialysis, or renal transplant. KFRE 5-year scores were analyzed by category (tertiles) and as a continuous variable. Results: Baseline KFRE score was available in 2,785 patients with tertiles: T1 (0.24 [0.16-0.34]), T2 (0.86 [0.63-1.16]), and T3 (2.62 [4.25-8.50]). Patients with higher 5-year KFRE scores were more likely to be male and had more severe CKD and HF. They also had a greater prevalence of diabetes, hypertension, and prior HF hospitalization, and were more likely to be treated with loop diuretics. As expected, higher KFRE scores were associated with a higher risk for the kidney outcome ( Figure A). However, higher KFRE scores were also associated with a higher risk of CV outcomes ( Figure B ). Compared with T1, the hazard ratios (95% CIs) in T3 were 2.68 (1.56-4.61) for the kidney outcome and 2.10 (1.74-2.52) for the composite of a first HF event or CV death. As a continuous variable, higher KFRE scores were associated with a steep increase in risk for the kidney outcome ( Figure C) ; for a first HF event or CV death, there was a less steep, linear increase in risk with increasing KFRE score ( Figure C) . Finerenone reduced the primary outcome, irrespective of baseline 5-year KFRE score analyzed as a continuous variable (P interaction =0.82) ( Figure D ). Conclusions: In patients with HFmrEF/HFpEF and CKD in FINEARTS-HF, higher KFRE scores were associated not only with a higher risk of kidney outcomes but also of CV outcomes. These findings suggest that the KFRE may provide clinically relevant prognostic information beyond the prediction of kidney failure in patients with HFmrEF/HFpEF. Finerenone reduced the risk of the primary outcome, irrespective of baseline 5-year KFRE score.