Clinical Efficacy of Finerenone in Diabetic Kidney Disease: A Retrospective Cohort Study

Background: Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has shown potential in managing diabetic kidney disease (DKD), but there is a lack of real-world data on its long-term inflammatory effects and safety in DKD patients. This study aimed to compare changes in proteinuria, inflammatory markers, and hepatic/renal function in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD) before and after finerenone treatment, thereby providing further evidence of its clinical benefits. Methods: After screening, 90 T2DM-CKD patients receiving finerenone (May 2023–Dec 2024) at the First Affiliated Hospital of Kunming Medical University were included. We compared baseline data with post-treatment (1/4/7 months) data, including proteinuria, inflammatory markers, and metabolic/safety parameters. Results: After 4 and 7 months of treatment, significant reductions were observed in urinary albumin-to-creatinine ratio (UACR), 24-hour urinary total protein, systolic C-reactive protein (CRP), serum fructosamine, hemoglobin A1c, microalbuminuria, and total protein compared to pre-treatment levels (P < 0.05). The UACR showed a progressive and significant reduction from baseline levels of 1046.21 ± 1487.43 mg/g to 659.35 ± 1143.98 mg/g post-treatment. CRP levels decreased significantly by 27.5% at 4 months and 30.6% at 7 months compared to baseline (P < 0.05). Hyperkalemia, hypotension, anemia, hyperuricemia, and hepatic impairment were not observed during the study's observation period. Conclusion: Finerenone significantly reduced urinary protein excretion and inflammatory markers in patients with T2DM-CKD, while also improving blood pressure and glycemic control. Limitations included the single-center design, small cohort, and short follow-up duration. Further large-scale, randomized trials are warranted to validate these findings. Funding: This work was supported by Yunnan Major Scientific and Technological Project, (grant no. 202102AA100060), Yunnan Province's Xingdian Talents Program for Renowned Physicians Support Plan. Funding: Other NIH Support - This work was supported by Yunnan Major Scientific and Technological Project, (grant no. 202102AA100060), Yunnan Province's Xingdian Talents Program for Renowned Physicians Support Plan., Government Support – Non-U.S.