What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetic nephropathy (n=240). Intervention: Finerenone plus ACEI/ARB vs. ACEI/ARB monotherapy. Primary outcome: Clinically meaningful renal deterioration defined as ≥15% decline in estimated glomerular filtration rate (eGFR) (aOR 0.473, 95% CI 0.253–0.883, p=0.019).

What does this research mean for the field?

Adding finerenone to ACEI/ARB therapy significantly improves eGFR in patients with type 2 diabetic nephropathy and reduces the risk of clinically meaningful eGFR decline. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To assess the efficacy and safety of adding finerenone to ACEI/ARB therapy in improving renal function for patients with diabetic nephropathy.

February 13, 2026Open Access

Effect of finerenone on renal function in patients with type 2 diabetic nephropathy: a retrospective cohort study

Key Result

Adding finerenone to ACEI/ARB therapy reduced the risk of clinically meaningful eGFR decline by 53% (adjusted OR 0.473, 95% CI 0.253–0.883, P=0.019) in patients with type 2 diabetic nephropathy over 24 weeks.

Key Points

To assess the efficacy and safety of adding finerenone to ACEI/ARB therapy in improving renal function for patients with diabetic nephropathy.
Conducted a retrospective cohort study with 240 adult patients diagnosed with diabetic nephropathy
Compared outcomes between patients receiving ACEI/ARB alone and those receiving ACEI/ARB plus finerenone
Evaluated renal and metabolic parameters at baseline and after 24 weeks of treatment
Used multivariable logistic regression to identify predictors of significant eGFR decline.
Patients receiving finerenone showed lower serum creatinine levels compared to controls (128.3 vs. 140.8 μmol/L)
Higher eGFR in the finerenone group (56.8 vs. 50.1 mL/min/1.73 m²)
Lower UACR in the finerenone group (301.4 vs. 398.7 mg/g)
Finerenone treatment was associated with a reduced risk of ≥15% eGFR decline (aOR = 0.473)
No increase in severe hyperkalemia or serious adverse events was observed.

Study Design

Type

Cohort (n=240)

Multicenter

Structured PICO

Does finerenone added to ACEI/ARB therapy improve renal parameters and prevent ≥15% eGFR decline in patients with type 2 diabetic nephropathy?

Population

240 adult patients (18–80 years) with a confirmed diagnosis of type 2 diabetic nephropathy (DN). Exclusions: type 1 diabetes, non-diabetic kidney disease, severe hepatic dysfunction, advanced heart failure, recent acute cardiovascular events, or baseline hyperkalemia.

Intervention

Finerenone 10 mg oral once daily added to ACEI/ARB therapy for 24 weeks

Comparator

ACEI/ARB monotherapy for 24 weeks

Outcome

Changes in renal parameters (Scr, eGFR, UACR) at 24 weeks and independent predictors of a ≥15% estimated glomerular filtration rate (eGFR) declinesurrogate

Adding finerenone to ACEI/ARB therapy in patients with type 2 diabetic nephropathy significantly improves renal parameters and reduces the risk of clinically meaningful eGFR decline over 24 weeks.

Main Result

Effect estimate: aOR 0.473 (95% CI 0.253–0.883)

p-value: p=0.019

Limitations

Retrospective observational design with potential selection bias and residual confounding
Short follow-up duration of 24 weeks precluding long-term outcome assessment
No stratification by concomitant use of other kidney protective therapies such as SGLT2 inhibitors
Hyperkalemia assessment relied on routine clinical laboratory testing which may underestimate transient biochemical events
Renal function assessed by creatinine-based eGFR and albuminuria without cystatin C or hard renal endpoints

Abstract

Background Diabetic nephropathy (DN) remains a major cause of chronic kidney disease despite optimized renin–angiotensin system blockade. This study aimed to evaluate the efficacy and safety of adding finerenone to angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) therapy and to identify predictors of clinically meaningful renal deterioration in patients with DN. Methods This retrospective cohort study enrolled adult patients (18–80 years) with a confirmed diagnosis of DN according to American Diabetes Association and Kidney Disease: Improving Global Outcomes criteria, who had complete baseline and follow-up data. Patients with type 1 diabetes, non-diabetic kidney disease, severe hepatic dysfunction, advanced heart failure, recent acute cardiovascular events, or baseline hyperkalemia were excluded. A total of 240 patients treated between January 2019 and December 2024 were included. Patients receiving ACEI/ARB monotherapy (control group, n = 124) were compared with those receiving ACEI/ARB plus finerenone (observation group, n = 116). Renal and metabolic parameters were assessed at baseline and after 24 weeks. Between-group comparisons were performed using appropriate parametric or nonparametric tests, and multivariable logistic regression analysis was conducted to identify independent predictors of a ≥15% estimated glomerular filtration rate (eGFR) decline. Results After 24 weeks, patients receiving finerenone showed significantly lower Scr (128.3 ± 27.6 μmol/L vs. 140.8 ± 35.1 μmol/L, P = 0.002), higher eGFR (56.8 ± 11.4 vs. 50.1 ± 12.3 mL/min/1.73 m², P 0.001), and lower UACR (301.4 ± 142.7 vs. 398.7 ± 176.8 mg/g, P 0.001) than controls. Finerenone treatment independently protected against renal deterioration (adjusted odds ratio aOR = 0.473, 95% CI: 0.253–0.883, P = 0.019), while longer diabetes duration, lower baseline eGFR, and higher UACR predicted ≥15% eGFR decline. Both regimens were well tolerated, with no increase in severe hyperkalemia or serious adverse events. Conclusions Adding finerenone to ACEI/ARB therapy improved renal parameters over 24 weeks and was independently associated with reduced risk of clinically meaningful eGFR decline without excess serious adverse events.

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