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

AIMS: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.