Early Efficacy and Safety of Finerenone on Type 2 Diabetes-Related Chronic Kidney Disease: A Real-World Observational Study in China

Aims

This observational study aimed to assess the early efficacy and safety of finerenone in patients with type 2 diabetes-related chronic kidney disease (CKD) in China with or without sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or renin-angiotensin system inhibitors (RASi).

Materials and Methods

Patients with type 2 diabetes-related CKD who initiated finerenone therapy between March 2023 and February 2024 at Zhongshan Hospital, Fudan University were retrospectively included. All patients were followed up at least once during the 12-week observation period. Key parameters, including urinary albumin/creatinine ratio (UACR), 24-h urine protein, serum creatinine, and potassium (K⁺) levels, were recorded. Estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine using the Collaborative Epidemiological Formula for Chronic Kidney Disease.

Results

A total of 105 patients (mean age, 59.4 ± 13.3 years; 81 males and 24 females) were included, with 82.9% diagnosed with diabetic nephropathy. After 12 weeks of finerenone treatment, UACR declined by 39.55%, with consistent results across all treatment groups, regardless of baseline eGFR or concomitant SGLT-2i/RASi use. A decline in eGFR > 30% occurred in 6.67% of patients, while a > 10% decline occurred in 61.9%. Hyperkalemia (serum K⁺ > 5.5 mmol/L) was observed in 8.57% of patients, mainly in those with eGFR < 60 mL/min/1.73 m², with the highest incidence (37.5%) in those with eGFR < 30 mL/min/1.73 m².

Conclusions

Finerenone effectively reduced albuminuria in patients with type 2 diabetes-related CKD; however, close monitoring of eGFR and serum K⁺ levels is essential, particularly in those with reduced baseline renal function.