The Safety of Finerenone in Patients with Chronic Kidney Disease during Ramadan Fasting

Abstract Introduction Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, is used in the management of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus and albuminuria. However, the safety of finerenone during Ramadan fasting has not been evaluated previously. This study aims to evaluate the clinical outcomes of finerenone use during Ramadan fasting in this patients group. Patients and Methods This retrospective cohort study was conducted at Tawam Hospital and Ambulatory Healthcare Services, United Arab Emirates, from July 2023 to July 2024. The study included patients on finerenone therapy and compared them to a control group of patients not using finerenone. Patients were further subdivided into Ramadan fasting and nonfasting groups. Baseline, during Ramadan, and post-Ramadan clinical and laboratory data were analyzed, including glycemic control (hemoglobin A1c [HbA1c]) and renal function (estimated glomerular filtration rate [eGFR]). To assess clinical outcomes and adverse events, descriptive and regression analyses were performed. Results A total of 42 finerenone-treated patients were compared with 271 controls. Patients in the finerenone group had higher rates of CKD and proteinuria and were on multiple antidiabetic medications. Among patients who observed Ramadan fasting, a decline in eGFR and a decrease in HbA1c were observed in the finerenone group compared with controls. Hypoglycemia was significantly higher in the finerenone group (36.7%) than in the non-finerenone group (13%). Finerenone use and the CKD stage were significant predictors of adverse events. Conclusion Our study highlights the potential risks associated with finerenone use during Ramadan fasting, including hypoglycemia and renal function decline. These findings emphasize the need for careful patient selection, individualized treatment adjustments, and close monitoring. Larger, prospective studies are needed to validate these observations and provide definitive guidance.