Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

El Diario de Pontevedra : periódico liberal: Ano XV Número 4310 - 1898 decembro 2

Capercaillie (Tetrao urogallus) and other grouse species represent conservation concerns across Europe due to their negative abundance trends. In addition to habitat deterioration, predation is considered a major factor contributing to population declines. While the role of generalist predators on grouse predation is relatively well known, the impact of the omnivorous wild boar has remained elusive. We hypothesize that wild boar is an important predator of ground-nesting birds, but has been neglected as a bird predator because traditional morphological methods underestimate the proportion of birds in wild boar diet. To distinguish between different mammalian predator species, as well as different grouse prey species, we developed a molecular method based on the analysis of mitochondrial DNA that allows accurate species identification. We collected 109 wild boar faeces at protected capercaillie leks and surrounding areas and analysed bird consumption using genetic methods and classical morphological examination. Genetic analysis revealed that the proportion of birds in wild boar faeces was significantly higher (17.3%; 4.5×) than indicated by morphological examination (3.8%). Moreover, the genetic method allowed considerably more precise taxonomic identification of consumed birds compared to morphological analysis. Our results demonstrate: (i) the value of using genetic approaches in faecal dietary analysis due to their higher sensitivity, and (ii) that wild boar is an important predator of ground-nesting birds, deserving serious consideration in conservation planning for capercaillie and other grouse

Bird consumption by wild boar in Estonia: Molecular method 4.5× more sensitive than the morphological.

<p>FO_Bird−frequency of occurrence of bird in wild boar diet; FO_Grouse−frequency of occurrence of grouse in wild boar diet.</p

Primer pairs used to identify mammal and bird species.

<p>Primer pairs used to identify mammal and bird species.</p

An Invasive Vector of Zoonotic Disease Sustained by Anthropogenic Resources: The Raccoon Dog in Northern Europe

<div><p>The raccoon dog (<i>Nyctereutes procyonoides</i>) is an introduced species in Europe with a continually expanding range. Since the species is capable of affecting local ecosystems and is a vector for a number of severe zoonotic diseases, it is important to understand its food habits. Raccoon dog diet was studied in Estonia by examining the contents of 223 stomach samples collected during the coldest period of the year, August to March, in 2010–2012. The most frequently consumed food categories were anthropogenic plants (e.g. cereals, fruits; FO = 56.1%) and carrion (e.g. carcasses of artiodactyls and carnivores; FO = 48.4%). Carrion was also the only food category that was consumed significantly more frequently by raccoon dogs exhibiting symptoms of sarcoptic mange than by uninfected animals. Small mammals, which represent intermediate hosts for the zoonotic tapeworm <i>Echinococcus multilocularis</i>, were more commonly recorded in samples also containing anthropogenic plants than expected by chance. Comparison of raccoon dog and red fox (<i>Vulpes vulpes</i>) diet in Estonia revealed higher overlap than found elsewhere in Europe, with ‘carrion’ and ‘anthropogenic plants’ making up the bulk of both species’ diet; however, raccoon dogs were more omnivorous than red foxes. Our results suggest that while the use of most food categories reflects the phenology of natural food sources, ‘anthropogenic plants’ and ‘carrion’ provide an essential resource for raccoon dogs during the coldest period of the year, with the latter resource especially important for individuals infected with sarcoptic mange. Since both of these food categories and small mammals are often found at supplementary feeding sites for wild boar (<i>Sus scrofa</i>), this game management practice may facilitate high densities of mesocarnivores and promote the spread of some severe zoonotic diseases, including alveolar echinococcosis, trichinellosis, rabies and sarcoptic mange.</p></div

Frequency of occurrence (FO) of different food items in the stomachs of raccoon dogs uninfected and infected with sarcoptic mange.

<p>Frequency of occurrence (FO) of different food items in the stomachs of raccoon dogs uninfected and infected with sarcoptic mange.</p

Non-metric multi-dimension scaling (NMDS; stress = 0.12) plots of raccoon dog diet between August and March in Estonia: a) samples are distinguished according to season (autumn or winter); b) the sex of the animal; or c) the mange infection status of the animal (infected or uninfected).

<p>Dashed ellipses indicate one standard deviation around the multivariate centroid of sample groups. PL-A – ‘anthropogenic plants’, PL-N – ‘natural plants’, BI – ‘birds’, SM – ‘small mammals’, CA – ‘carrion’, AM – ‘amphibians’, FI – ‘fish’, IN – ‘invertebrates’, GA – ‘garbage’.</p

Co-occurrence of food items in raccoon dog diet.

<p>Numbers of samples in which a particular food type was recorded is shown in parentheses. Cells below the diagonal show the number of samples in which food types co-occurred. Cells above the diagonal show the standardised C-score (values below zero indicate co-occurrence; values above zero indicate separation). C-scores that deviate significantly from a random null model are shown in bold typeface. PL-A – anthropogenic plants, PL-N – natural plants, BI - birds, SM – small mammals, CA - carrion, AM - amphibians, FI - fish, IN - invertebrates, GA – garbage.</p

Frequency of occurrence (FO) and the number of different mammal taxa (n) found in the stomachs of raccoon dogs in Estonia in autumn and winter 2010–2012 (n = 223).

<p>Frequency of occurrence (FO) and the number of different mammal taxa (n) found in the stomachs of raccoon dogs in Estonia in autumn and winter 2010–2012 (n = 223).</p