1403-P: Effects of Finerenone on Chronic Kidney Disease in Patients with Type 2 Diabetes: Association with Metabolic Dysfunction–Associated Steatotic Liver Disease

Introduction and Objective: Diabetes and obesity can induce excessive mineralocorticoid receptor (MR) activation, leading to the progression of nephropathy and cardiovascular disease. In this study, we investigated the effects of finerenone on the annual rate of decline in eGFR and its association with metabolic dysfunction-associated steatotic liver disease (MAFLD). We examined the relationship between changes in plasma aldosterone levels after finerenone administration and improvement in eGFR. Methods: The study included patients with type 2 diabetes who had albuminuria, an eGFR ≥30 mL/min/1.73 m², had been treated with finerenone for one year. Renal function was assessed using the annual eGFR decline before and after finerenone treatment. In study 1, the annual eGFR decline were compared between patients with and without MAFLD. In study 2, plasma aldosterone concentration (PAC) were measured before and after finerenone treatment. These parameters were compared between patients who showed improvement in the annual eGFR decline and those who did not. Results: In study 1, 35 patients were analyzed. The annual eGFR decline improved significantly from −4.35 ± 7.57 to 0.50 ± 6.69 ml/min/1.73 m²/year after finerenone administration (p < 0.001). Among the 27 patients with improved eGFR decline, 18.5% had MAFLD, whereas 55.5% of the 9 patients with unchanged or worsened eGFR decline had MAFLD, a significantly higher proportion (p < 0.01).In study 2, 21 patients were analyzed. PAC increased significantly after finerenone treatment. PAC levels were significantly lower in the eGFR improvement group (14 patients; 32.8 ± 37.4 pg/ml) compared with the non-improvement group (7 patients; 71.4 ± 49.0 pg/ml; p < 0.05). Conclusion: In patients with type 2 diabetes complicated by CKD and albuminuria, finerenone improved the annual eGFR decline, suggesting a potential renoprotective effect. However, the presence of MAFLD or elevated plasma aldosterone levels may attenuate the renoprotective effects of finerenone. Disclosure M. Higa: None. T. Ichijo: None.