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.
Cohort (n=240)
No
Does finerenone added to ACEI/ARB therapy improve renal parameters and prevent ≥15% eGFR decline in patients with type 2 diabetic nephropathy?
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.
Effect estimate: aOR 0.473 (95% CI 0.253–0.883)
p-value: p=0.019
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.
Liu et al. (Tue,) conducted a cohort in Type 2 diabetic nephropathy (n=240). Finerenone plus ACEI/ARB vs. ACEI/ARB monotherapy was evaluated on 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). 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.