Effectiveness and Safety of Finerenone in Patients With Diabetic Kidney Disease: A Real-World Observational Study

Finerenone is approved for the treatment of diabetic kidney disease (DKD), but real-world evidence remains limited. We evaluated the effectiveness and safety of finerenone in routine clinical practice.

This retrospective observational study included patients with DKD who were prescribed finerenone. Effectiveness was assessed by measuring changes in urine protein-to-creatinine ratio (UPCR) and urine albumin-to-creatinine ratio (UACR) over the 6-month period following initiation of finerenone. Changes in estimated glomerular filtration rate, blood pressure, potassium levels, renin, and aldosterone were also monitored.

A total of 404 patients with DKD were analysed. After 6 months of finerenone treatment, UPCR and UACR decreased substantially, with mean within-subject changes of -820.2 ± 1528.3 and -606.4 ± 1119.6 mg/g, respectively. 59.9% of patients achieved a ≥ 30% reduction in UPCR from baseline. Patients who were older, had lower baseline potassium levels, and received a higher mean daily dose of finerenone exhibited a more favourable response to finerenone. The mean increase in potassium levels was 0.3 mEq/L at 6 months, and the treatment discontinuation rate due to hyperkalemia was 5.4%. The aldosterone-to-renin ratio showed a modest decrease at 3 months (mean within-subject change, -3.79 ± 13.76 ng/dL per ng/mL/h), with borderline statistical significance.

Finerenone treatment was associated with a significant reduction in proteinuria in patients with DKD. The safety profile was comparable to that reported in previous studies.