Association of finerenone plus tripterygium glycosides with proteinuria reduction in patients with diabetic kidney disease: a retrospective cohort study

Objective We aimed to investigate the association of combined finerenone and tripterygium glycosides (TG) therapy with proteinuria reduction in patients with diabetic kidney disease (DKD). Methods This retrospective cohort study included patients with DKD and an estimated glomerular filtration rate (eGFR) of 15 to <60 mL/min/1.73 m 2 who received finerenone alone (n = 167) or finerenone plus TG (n = 36) during January, 2023–April 2026. Longitudinal urinary albumin-to-creatinine ratio (UACR) was evaluated using adjusted linear mixed-effects models. Multiple subgroup and sensitivity analyses were performed to assess the robustness of the findings. Associations between treatment groups and adverse events, including hyperkalemia, elevated liver transaminases, and a ≥1.5-fold increase in serum creatinine, were also evaluated. Results Among the 203 patients, the mean age was 65.1 years, the median UACR was 872.6 [273.8, 1723.1] mg/g, and the median eGFR was 46.2 [36.4, 53.3] mL/min/1.73 m 2 . Relative to finerenone alone, combination therapy was associated with an additional UACR reduction of 14.7% per 6 months (95% confidence interval [CI], [5.6%, 22.8%]; P = 0.002), equivalent to 27.5% per year (95% CI, [11.1%, 40.9%]). Combination therapy was associated with a higher rate of achieving a ≥50% reduction in UACR than finerenone alone (adjusted hazard ratio [HR], 2.02; 95% CI, 1.17–3.48; P = 0.011). During follow-up, serum potassium increased to a greater extent in the combination therapy group (P = 0.031), whereas longitudinal changes in serum creatinine and eGFR did not differ significantly between the groups (both P > 0.05). However, the incidences of hyperkalemia and liver and kidney-related adverse events were also comparable between the groups (all P > 0.05). Conclusion In patients with DKD and an eGFR of 15 to <60 mL/min/1.73 m 2 , combination therapy with TG and finerenone was associated with a greater reduction in UACR than finerenone alone, without a significant increase in the risk of the assessed adverse events. Further evaluation in prospective randomized trials is warranted.