Credit: Original article published here.There are limited treatment options to reduce persistent cardiovascular and renal risk in patients with type 2 diabetes and stage 4 chronic kidney disease (CKD). Results of FIDELITY, a prespecified pooled analysis of FIDELIO-DKD (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) and FIGARO-DKD (Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease) demonstrated that heart-kidney outcomes were improved in participants with CKD and type 2 diabetes who were treated with finerenone. Pantelis Sarafidis, MD, and colleagues conducted a FIDELITY subgroup analysis to examine the effects of finerenone among participants with stage 4 CKD (defined as estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2). Efficacy outcomes of interest were a cardiovascular composite (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) and a kidney composite (kidney failure, sustained ≥57% decrease in eGFR from baseline, or kidney disease death). Results were reported online in the Clinical Journal of the American Society of Nephrology [doi:10.2215/CJN.0000000000000149]. FIDELITY included 13,023 participants. Of those, 7% (n=890) had stage 4 CKD. The hazard ratio for risk of the cardiovascular composite outcome with finerenone versus placebo among participants with stage 4 CKD was 0.78