Efficacy and Safety of Finerenone in Patients Aged 65 Years or Older with Diabetic Kidney Disease: Subgroup Analysis of the FINDKDLATAM Study

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Background and Objectives: Diabetic kidney disease (DKD) is one of the leading causes of chronic kidney disease (CKD) worldwide. Individuals over 65 years of age with type 2 diabetes mellitus (T2DM) constitute a growing age group that is frequently underrepresented in randomized clinical trials. Finerenone has been shown to reduce renal progression and cardiovascular events in patients with albuminuric DKD. To evaluate the clinical and laboratory characteristics as well as the therapeutic response and safety profile of finerenone in patients over 65 years of age with DKD, based on data from the FINDKDLATAM observational study cohort. Materials and Methods: Subgroup analysis of a real-life, retrospective, multicenter observational study—the FINDKDLATAM cohort. For the present analysis, patients aged ≥ 65 years were stratified. Sociodemographic, clinical, paraclinical, and treatment variables and adverse events were evaluated. The descriptive analysis used medians with interquartile ranges (IQRs) for continuous variables of non-parametric distribution and absolute and relative frequencies for categorical variables. The comparison of baseline parameters and those at six months of follow-up was performed using non-parametric tests, with statistics. Results: Of the total of 347 patients included in the original study, 157 (45.2%) were ≥65 years of age. The median age was 72 years. The baseline profile showed a median glomerular filtration rate (eGFR) of 38.0 mL/min/1.73 m2 (IQR: 30.0–50.75), as well as elevated albuminuria (ACR 327.0 mg/g; IQR: 186.5–805.5). In addition, the patients had a high burden of comorbidities. 58.0% of patients received finerenone at a dose of 10 mg and 42.0% at a dose of 20 mg. After six months of follow-up, a significant reduction in the median ACR was observed, decreasing from 327.0 mg/g (IQR: 186.5–805.5) to 78.0 mg/g (IQR: 27.5–143.0), corresponding to a decrease of 76% (p < 0.0001). Regarding safety, hyperkalemia occurred in 20.3% of patients, although, in all cases, it was mild hyperkalemia (potassium between 5.1 and 5.5 mEq/L), with no serious episodes or treatment suspensions attributable to this event. Conclusions: In this cohort of Latin American adults over 65 years of age with albuminuric DKD, finerenone demonstrated good efficiency given the clinically significant reduction of albuminuria with stable renal function at six months of treatment, also demonstrating a safety profile, with a low risk of hyperkalemia.

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