Early experience with finerenone in patients with heart failure and diabetic kidney disease: 6 months of real-world cohort follow-up

Background Finerenone is a novel non-steroidal mineralocorticoid receptor antagonist (MRA), that has shown promising results in clinical trials by reducing kidney disease progression and cardiovascular events. However, real-world data on its effectiveness and safety remain limited. Purpose To determine the effectiveness and safety of finerenone in the treatment of HF and DKD in a real-world cohort, analyzing the impact on HF-admissions, cardiovascular (CV) events, renal function, and side effects. Methods Prospective, observational study including patients with HF and DKD receiving finerenone. Patients were followed for a 6-months period. Clinical characteristics, laboratory parameters, echocardiographic findings, treatment and hospitalization were analyzed. Results A total of 32 patients were included. The mean age was 73.5 years and 28,1% were female. 81.3% of patients started treatment at a dose of 10 mg, and 18.8% at 20 mg. During the follow-up period, 51.6% of patients were on 10 mg, and 48.4% were on 20 mg. A significant reduction in both hospitalizations and episodes of HF decompensation was observed, regardless of left ventricular ejection fraction. 9.4% of patients were hospitalized compared to 37.5% before starting finerenone. Moreover, the frequency of HF decompensations decreased from a mean of 0.66 ± 0.75 to 0.13 ± 0.42 (p < 0.001) Figure 1. No patient was hospitalized due to a CV event during the follow-up. Regarding renal outcomes, no significant changes in estimated glomerular filtration rate (eGFR) were observed (p = 0.8). However, finerenone significantly reduced the median urine albumin-to-creatinine ratio (UACR) throughout the study period (p = 0.012), with a 47.5% decline from baseline, decreasing from 120 (45–298) mg/g to 63 (24–259) mg/g. Figure 2. No significant changes were observed in hospitalizations due to renal causes (p = 0.414). Hyperkalemia was the most common event, affecting 17 patients (53.1%), followed by worsening renal function, which affected 2 (6.3%). Severe hyperkalemia occurred in 6 (15.3%), with 4 (66.66%) having potassium levels above 6.5 mmol/L, leading to temporary discontinuation of the medication, and 16 (65%) required the use of potassium binders to manage hyperkalemia (Calcium polystyrene sulfone 25.1% and soidium zirconium cyclosilicate 25%). One patient died from cardiac arrest related to hyperkalemia, and another experienced gastrointestinal intolerance that prevented continuation of the treatment. Conclusion In this real-world cohort of patients with HF and DKD, finerenone was associated with a significant reduction in HF hospitalizations and decompensations, confirming its cardiovascular benefit. Although no significant changes in eGFR were observed, the substantial reduction in albuminuria suggests a renoprotective effect. Hyperkalemia was the most common adverse event; thus, close potassium monitoring, especially during the initial months of treatment, is essential.Figure 1.Cardiac outcomes. Figure 2.Renal outcomes.