Primary Literature Evaluation Practice Test

A 58-year-old man (92 kg) with type 2 diabetes has persistent albuminuria (urine albumin-to-creatinine ratio 420 mg/g) despite lisinopril 20 mg daily; estimated glomerular filtration rate (eGFR) is 48 mL/min/1.73 m$^2$ and potassium is 4.6 mEq/L. You review a randomized, double-blind, placebo-controlled trial in adults with type 2 diabetes, eGFR 25–75, and albuminuria on maximally tolerated angiotensin-converting enzyme inhibitor or angiotensin receptor blocker: finerenone 20 mg daily (10 mg if eGFR 25–60) vs placebo for a median 2.6 years; the primary composite kidney outcome (kidney failure, sustained ≥40% eGFR decline, or renal death) occurred in 17.8% vs 21.1% (hazard ratio 0.82; 95% confidence interval 0.73–0.93; p=0.001), with hyperkalemia leading to discontinuation in 2.3% vs 0.9%. Based on the study, which treatment is most appropriate for this patient?

A 76-year-old man (78 kg) with hypertension and osteoarthritis has chronic kidney disease stage 3a (eGFR 52 mL/min/1.73 m$^2$) and takes ibuprofen most days. He asks about starting low-dose aspirin for primary prevention. You review a randomized, double-blind trial in adults ≥70 years without cardiovascular disease: aspirin 100 mg daily vs placebo for a median 4.7 years; major cardiovascular events were 10.7 vs 11.3 per 1000 person-years (hazard ratio 0.95; 95% confidence interval 0.83–1.08; p=0.40) while major bleeding was 8.6 vs 6.2 per 1000 person-years (hazard ratio 1.38; 95% confidence interval 1.18–1.62; p<0.001). How should the study's findings influence this patient's treatment plan?