Real‐World Effectiveness and Safety of Finerenone in People With Type 2 Diabetes and Chronic Kidney Disease: A Spanish Multicentre Retrospective Observational Study ( <scp>MEDFINE</scp> ‐ <scp>RWD</scp> )

ABSTRACT Aim Although finerenone has shown efficacy in randomized trials, evidence from routine clinical practice remains limited. We aimed to assess the real‐world effectiveness and safety of finerenone in people with type 2 diabetes (PWT2D) and chronic kidney disease (CKD), with a particular focus on residual cardiorenal risk as reflected by changes in urinary albumin‐to‐creatinine ratio (UACR). Materials and Methods MEDFINE‐RWD was a multicentre, retrospective study across eight Spanish centres, enrolling patients initiating finerenone (June 2024–December 2025). The primary endpoint was a ≥ 30% reduction in UACR. Multivariable logistic regression identified response predictors. Secondary outcomes included safety (hyperkalaemia ≥ 5.5 mmol/L, major kidney [MAKE] and cardiovascular events [MACE]). Results Among 844 participants (median age 72 years; median follow‐up 184 days; 76.8% male; baseline eGFR 49 mL/min/1.73 m 2 ; UACR 285 mg/g; 77.8% were at high/very high KDIGO risk), finerenone was associated with a 34.5% median UACR reduction at 6 months ( p &lt; 0.001), despite intensive SGLT2 inhibitors (88.4%) and GLP‐1 receptor agonists (35.7%) use. The primary endpoint was achieved by 52.7%, consistently across background renoprotection or baseline KDIGO risk strata. Predictors of response were age ≥ 70 (aOR 2.12), baseline UACR &gt; 245 mg/g (aOR 1.94), and BMI &gt; 27 kg/m 2 (aOR 1.84), while insulin use was associated with lower response odds. Treatment persistence was 89.5%, with low incidences of hyperkalaemia (4.8%), MAKE (0.9%), and MACE (1.1%). Conclusions In real‐world practice, finerenone was associated with a substantial reduction in albuminuria. Finerenone demonstrated high persistence and a favourable safety profile, irrespective of baseline renoprotective regimens or KDIGO risk.