Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in CKD

Background: Recent progress in treating CKD include utilizing SGLT2 inhibitors and selective mineralocorticoid receptor antagonists, finerenone. This real-world experience retrospective study examines the effects of these treatments, individually and in combination on CKD patients. Methods: 98 adults patients with CKD, an eGFR 25 to 90 ml/min per 1.73 m2 and a urine albumin/creatinine ratio (UACR) > 30 mg/g were included. The patients were divided into 3 groups with 8 months follow-up: group one (N=52) treated with SGLT2 inhibitors, group two (N=22) treated with finerenone, and group three (N=24) treated with combination therapy- SGLT2i inhibitors for the first 4 months then finerenone was subsequently added. The primary outcome was the percentage of patients achieving >50% reduction in UACR from baseline. Results: For all patients, the mean eGFR was 51.0 ml/min per 1.73m2, and median UACR was 580 mg/g. After 8 months, >50% decrease in albuminuria was achieved in 96% of patients in group 3, compared to 50% in group 1 and 59% in group 2 (P-values <0.01 and <0.01 respectively) (Fig 1A). When we assessed percent albuminuria reduction adjusted for baseline covariates, there was a significant difference comparing group 1 (45%, 95% CI [32,58]) to group 3 (73%, 95% CI [53,92]) with difference reduction of 28% (95% Cl [16,38], p-value < 0.01) (Fig 1B). Despite observing a substantial reduction in albuminuria in group 3 compared to group 2, the difference was 18% (95% Cl: [-0.1,31]) and did not reach statistical significance (p-value 0.07) (Fig 1B). There was a significant change in mean potassium levels in group 2 (+0.4 mmol/L) compared to either group 1 (0.0 mmol/L, p-value: < 0.01) or group 3 (-0.01 mmol/L, p-value: < 0.01) (Fig 1C). However, there was no difference comparing group 1 and 3 (Fig 1C). Conclusion: In this real-world experience, the combination of SGLT2 inhibitors and finerenone in CKD patients was associated with a significant reduction in UACR, without an increased risk of hyperkalemia.