#798 Real-life study of finerenone, efficacy and safety assessment

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Abstract Background and Aims Finerenone is a novel synthetic nonsteroidal mineralocorticoid receptor antagonist (MRA) that specifically targets the mineralocorticoid receptor in renal tissues. It has been shown to exert nephroprotective effects, particularly in patients with diabetic kidney disease (DKD), which is characterized by progressive renal dysfunction and often leads to end-stage renal disease. Unlike traditional MRAs, finerenone offers a more selective mechanism of action, which mitigates the risk of adverse effects, particularly hyperkalemia, a common concern associated with mineralocorticoid receptor blockade. The recent approval of finerenone for clinical use represents a significant advancement in the management of DKD, enhancing the therapeutic options available to clinicians. This study aims to assess the impact of initiating finerenone one month after treatment onset on estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), and potassium (K+) levels in patients with DKD treated with the maximum tolerated and stable doses of renin angiotensin system inhibitors (RASi) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i) for the previous six months. Method Retrospective analysis of patients with diabetic kidney disease (DKD) initiating finerenone 10 mg/day. Demographic, clinical, and laboratory parameters were collected at baseline and one month post-treatment, including glucose, creatinine, eGFR (CKD-EPI), ACR, urea, potassium, and baseline HbA1c. Statistical analysis using SPSS v29 included descriptive statistics and comparison of pre/post-treatment values using paired t-tests or Wilcoxon test as appropriate (significance P < 0.05). Results Fifteen patients (53.33% male, mean age 71.8 ± 10.5 years) were analyzed. At one month (n = 15), ACR showed a significant median reduction of 58 mg/g (IQR: 19.9–492.5; P = 0.034). Potassium levels showed non-significant increases of 0.12 mEq/L. eGFR remained stable throughout the study period. Treatment discontinuation occurred in two patients (13.3%): one due to hyperkalemia and another due to treatment inefficacy. Conclusions Finerenone demonstrated a favorable safety profile with minimal treatment discontinuation (2/15 patients) and no significant increases in potassium levels in a real-world elderly population with advanced CKD. • A 29.11% reduction in microalbuminuria was observed after one month of treatment, although not reaching statistical significance (P = 0.161), in patients with diabetic kidney disease receiving standard therapy. • Further research with larger sample sizes and extended follow-up periods is warranted to establish long-term efficacy and safety in real-world settings.

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