Therapeutic Efficacy of Finerenone and Risk Factors for Kidney Function Changes in Early Stage for Patients with Type 2 Diabetes and CKD

Background: Finerenone has been demonstrated reno-protective in T2DM and chronic kidney disease (CKD) patients. This study aims to evaluate the real-world effects of a three-month finerenone treatment in patients with T2DM and CKD and analyze the risk factors for renal function changes during treatment. Methods: A total of 151 patients with T2DM and CKD who were treated with finerenone for 3 months in Beijing Anzhen Hospital, Capital Medical University from April 2023 to October 2023 were collected in this retrospective cohort study. Clinical data were collected before and after finerenone treatment. The urinary albumin creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), serum potassium levels were measured before and after treatment, analyzing the risk factors of renal function changes during the treatment. Results: The individuals included were on an median age of 63 (54, 70)years, 103 males accounted for 68.2%. After 3 months treatment of finerenone, UACR was significantly decreased[142.68(49.9, 754.56)mg/g vs 220.89(83.07, 912.88)mg/g，Z=-5.051, P=0.001], while eGFR showed no significant changes post-treatment (70.44±23.62ml/min/1.73m2 vs 70.86±24.43ml/min/1.73m2, t=0.537, P=0.592). After subgrouped by baseline eGFR and UACR, the two groups both showed significant reductions in UACR, with a higher percentage of UACR reduction in baseline UACR≥300mg/g group compared with UACR＜300mg/g group(35.2% vs 23.7%, P=0.036). Serum potassium remained unchanged post-treatment (4.46±0.39mmol/L vs 4.41±0.42mmol/L, t=-1.519, P=0.131). While the incidence of hyperkalemia was significantly higher in the baseline eGFR<60ml/min/1.73m2 group (21.4% vs 7.1%, P=0.039). 30 patients (19.9%) had renal function changes during treatment, which indicated a decrease of each 5g/L with baseline serum albumin＜45g/L, which increased the risk of renal function changes by 93.4%(OR=1.934, 95% CI 1.157~3.231, P=0.012). Conclusion: UACR in patients with T2DM and CKD can be reduced significantly after 3 months treatment of finerenone, especially in patients with UACR≥300mg/g, which cannot be influenced with basic renal function. For patients with serum albumin < 45g/L, with the decrease of serum albumin, we should be alert to the risk of renal function progression at the initial stage of finerenone treatment.