Endocrine Abstracts

JOINT2204

Background and Aims: Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has been shown to reduce albuminuria and slow chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (T2DM). However, real-world data on its impact on kidney function and albuminuria reduction in patients with different CKD stages remain limited. This study aimed to evaluate the effects of finerenone on estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) in patients with T2DM and CKD stages 3A–4.

Materials and Methods: A total of 45 patients with T2DM and CKD stages 3A–4 were included in the study. The mean age was 63.3 ± 5.7 years, with a diabetes duration of 7.2 ± 4.5 years (data are presented as mean ± SD). The baseline HbA1c was 7.6 ± 0.15%, serum creatinine 115.6 ± 3.7 µmol/l, and potassium 4.1 ± 0.07 mmol/l. Patients were stratified by CKD stage: 28 with stage 3A (eGFR 45–60 mL/min/1.73m²), 10 with stage 3B (eGFR 30–44 mL/min/1.73m²), and 7 with stage 4 (eGFR 25–30 mL/min/1.73m²). Baseline ACR was <30 mg/g in 27 patients, 30–300 mg/g in 14 patients, and >300 mg/g in 4 patients. Finerenone was initiated at 10 mg/day in patients with eGFR 25–59 mL/min/1.73m² and 20 mg/day in those with eGFR ≥60 mL/min/1.73m², with monthly potassium monitoring and dose adjustments as needed. The data were compared using Student’s t-test and correlation analysis.

Results: After 3 months of treatment, eGFR increased by 6% (54.04 ± 2.35 mL/min/1.73m², P < 0.05), while ACR decreased by 13% (46.27 ± 14.57 mg/g, P < 0.05). The most pronounced improvement in eGFR and ACR was observed in patients with CKD stage 3A and 3B. A significant inverse correlation was found between eGFR and ACR (ρ = -0.62, P < 0.05), with the strongest association in CKD stage 3A (ρ = -0.71). Serum potassium levels remained stable (4.04 ± 0.04 mmol/l, p > 0.05), and no cases of hyperkalemia (>5.0 mmol/l) were reported.

Conclusion: Finerenone effectively improved kidney function and reduced albuminuria in patients with T2DM and CKD stages 3A–4. The most significant benefits were observed in patients with CKD stage 3A–3B. Treatment was well tolerated, with no significant hyperkalemia. These findings support the use of finerenone in early-stage diabetic kidney disease to slow disease progression.