Endocrine Abstracts

JOINT264

Background: Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease. Finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), has demonstrated renoprotective effects in patients with DKD. However, not all patients respond equally to finerenone therapy. Identifying predictive markers for poor response is crucial for personalized management. This study aimed to investigate potential predictive markers associated with suboptimal response to finerenone in patients with DKD.

Methods: This prospective cohort study included 140 patients with DKD (estimated glomerular filtration rate [eGFR] 25-75 ml/min/1.73 m² and urinary albumin-to-creatinine ratio [UACR] ≥30 mg/g) who were initiated with finerenone therapy. Patients were followed for 12 months. Poor response was defined as a less than 15% reduction in UACR or a decline in eGFR of more than 5 ml/min/1.73 m² at end of one year. Baseline clinical and laboratory parameters, including age, sex, HbA1c, blood pressure, eGFR, UACR, serum potassium, sodium, uric acid, and inflammatory marker (high-sensitivity C-reactive protein [hs-CRP]), were analyzed as potential predictors. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of poor response.

Results: Of the 140 patients, 45 (32.14%) were classified as poor responders to finerenone therapy. Univariate analysis revealed that baseline eGFR (OR 0.95, 95% CI 0.92-0.98, P=0.001), UACR (OR 1.001, 95% CI 1.000-1.002, P=0.03), hs-CRP (OR 1.25, 95% CI 1.08-1.45, P=0.003), and uric acid (OR 1.15, 95% CI 1.02-1.30, P=0.02) were significantly associated with poor response. In multivariate analysis, baseline eGFR (OR 0.96, 95% CI 0.93-0.99, P=0.01) and hs-CRP (OR 1.20, 95% CI 1.03-1.40, P=0.02) remained independent predictors of poor response to finerenone.

Conclusion: This study suggests that baseline eGFR and hs-CRP are independent predictors of poor response to finerenone therapy in patients with DKD. These findings highlight the importance of considering these markers in clinical practice to identify patients who may require closer monitoring or alternative treatment strategies. Further prospective studies are needed to validate these findings and explore the underlying mechanisms contributing to the observed associations.

References: 1. Bakris GL, et al. Finerenone in patients with chronic kidney disease and type 2 diabetes. N Engl J Med. 2020;383(23):2219-2229.

2. Rossing K, et al. Finerenone and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes (FIDELIO-DKD): a double-blind, randomised, placebo-controlled trial. Lancet. 2021;396(10256):1055-1065.