Key result
Finerenone linked to ~33% reduction in median UACR at 4 months in routine practice.
Why the study?
Following the 2021 US approval of finerenone for CKD and T2D, real-world patient characteristics and short-term outcomes since regulatory approval were not yet described.
Does finerenone improve urine albumin-to-creatinine ratio in adults with chronic kidney disease and type 2 diabetes?
Cohort (n=15,948)
Yes
Does finerenone improve urine albumin-to-creatinine ratio in adults with chronic kidney disease and type 2 diabetes?
Finerenone use in US real-world clinical practice achieved substantial early reductions in albuminuria with low rates of hyperkalemia, supporting its broad adoption across the CKD severity spectrum.
Finerenone was associated with early UACR reduction in real-world CKD/T2D; leaves open effects on hard outcomes.
INTRODUCTION: In 2021, finerenone - a novel, selective nonsteroidal mineralocorticoid receptor antagonist - was approved in the USA to treat adults with chronic kidney disease (CKD) and type 2 diabetes (T2D). This study aimed to describe characteristics and short-term outcomes of patients prescribed finerenone since regulatory approval. METHODS: This was a retrospective cohort study using claims and electronic health records data from the OM1 Real-World Data Cloud™. A total of 15,948 US adults with a previous diagnosis of CKD and T2D who initiated 10 mg or 20 mg finerenone between July 2021 and August 2023 were included. Dosing was evaluated at baseline and over up to 12-month follow-up. Change from baseline in urine albumin-to-creatinine ratio (UACR) was evaluated at 4 and 12 months (among 913 and 443 patients, respectively, with available repeat UACR values). Hyperkalemia occurrence was determined at 12 months and over total follow-up. RESULTS: Median follow-up was 7.2 months. Mean age was 70.3 years, and 44.1% were female. At baseline (-365; 0 days), 70% had CKD stage 3; for patients with UACR measurements, 80.8% had moderate/severe albuminuria (≥30 mg/g). Median UACR was 203 mg/g. Co-medication use was ACE inhibitors/ARBs (51%), SGLT2is (38%), and GLP-1 RAs (26%). 86% of patients initiated 10 mg finerenone, and among 2,212 patients still under observation at 12 months, 70% were on 10 mg. For finerenone initiators with available UACR data, UACR was reduced by 33% at 4 months and 38% at 12 months. Hyperkalemia occurred in 1.2% of the cohort by 12 months (incidence 2.0 per 100 person-years). CONCLUSION: Patients who initiated finerenone had a notable reduction in median UACR at 4 months, sustained at 12 months; hyperkalemia occurrence appeared to be low. These initial findings from US clinical practice should be complemented by results from other real-world cohorts of patients started on finerenone.
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Kövesdy et al. (2025) conducted a cohort in Chronic kidney disease and type 2 diabetes (n=15,948). Finerenone was evaluated on Relative change in median UACR from baseline at 4 months (-33.2% relative change, 95% CI -48.1 to -18.3). Finerenone exposure in routine clinical practice was associated with a 33.2% relative reduction in median urine albumin-to-creatinine ratio at 4 months.
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