Finerenone versus spironolactone in patients with chronic kidney disease and type 2 diabetes: a target trial emulation

The comparative effectiveness of finerenone and spironolactone in chronic kidney disease (CKD) with type 2 diabetes (T2D) remains unclear. Here we show, using a target trial emulation on global real-world data from TriNetX, outcomes among 2268 propensity score-matched adults with CKD (eGFR 15-60 mL/min/1.73 m²) and T2D who initiated finerenone or spironolactone between July 2021 and September 2024. Over a median follow-up of 1.3 years, finerenone is associated with lower risks of major adverse cardiovascular events (adjust hazard ratio [aHR], 0.74; 95% CI, 0.58-0.94), major adverse kidney events (aHR, 0.47; 95% CI, 0.33-0.67), all-cause mortality (aHR, 0.31; 95% CI, 0.21-0.45), and hyperkalemia (17.2% vs. 26.4%; P < 0.001) compared with spironolactone. These findings suggest potential benefits of finerenone over spironolactone in reducing mortality and cardiorenal risk among patients with CKD and T2D.

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Publication Details

Journal
Nature Communications
Published
2025-10-31
DOI
https://doi.org/10.1038/s41467-025-64640-3
Citations
9
Primary Topic
Hormonal Regulation and Hypertension
Type
article
Field-Weighted Citation Impact
11.65

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article

Finerenone versus spironolactone in patients with chronic kidney disease and type 2 diabetes: a target trial emulation

Yen‐Ling Chiu, Vin‐Cent Wu, Shuo‐Meng Wang, Jui‐Yi Chen et al.
9 citations
Nature Communications
Hormonal Regulation and Hypertension
11.65
article

Finerenone versus spironolactone in patients with chronic kidney disease and type 2 diabetes: a target trial emulation

Yen‐Ling Chiu, Vin‐Cent Wu, Shuo‐Meng Wang, Jui‐Yi Chen, Li-Chun Lin, Hsuan-Wen Lai, Chung-An Wang, Chung-Yi Cheng
article en
9 citations

Abstract

The comparative effectiveness of finerenone and spironolactone in chronic kidney disease (CKD) with type 2 diabetes (T2D) remains unclear. Here we show, using a target trial emulation on global real-world data from TriNetX, outcomes among 2268 propensity score-matched adults with CKD (eGFR 15-60 mL/min/1.73 m²) and T2D who initiated finerenone or spironolactone between July 2021 and September 2024. Over a median follow-up of 1.3 years, finerenone is associated with lower risks of major adverse cardiovascular events (adjust hazard ratio [aHR], 0.74; 95% CI, 0.58-0.94), major adverse kidney events (aHR, 0.47; 95% CI, 0.33-0.67), all-cause mortality (aHR, 0.31; 95% CI, 0.21-0.45), and hyperkalemia (17.2% vs. 26.4%; P < 0.001) compared with spironolactone. These findings suggest potential benefits of finerenone over spironolactone in reducing mortality and cardiorenal risk among patients with CKD and T2D.

Nature CommunicationsVol. 16(1)
Ministry of Health and Welfare (KR), Chung Yuan Christian University (TW), Far Eastern Memorial Hospital (TW), Ministry of Health and Welfare (TW), Cathay General Hospital (TW), National Taiwan University Hospital (TW), Chi Mei Medical Center (TW), Wan Fang Hospital (TW), Taipei Medical University (TW), Chia Nan University of Pharmacy and Science (TW), Yuan Ze University (TW)
National Taiwan University Hospital, National Taiwan University, National Science and Technology Council
Openalex Percentile: Top 1%
Hormonal Regulation and Hypertension
11.65
DOIOpen Access PDFOpenAlex
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