Finerenone is approved for the treatment of diabetic kidney disease (DKD), but real-world evidence remains limited. A retrospective observational study published in Diabetes, Obesity and Metabolism evaluated the effectiveness and safety of finerenone in routine clinical practice.

The study included 404 patients with DKD who were prescribed finerenone. Changes in urine protein-to-creatinine ratio (UPCR) and urine albumin-to-creatinine ratio (UACR) were assessed over a 6-month follow-up period. Changes in estimated glomerular filtration rate, blood pressure, potassium levels, renin, and aldosterone were also monitored.

After 6 months, mean within-subject UPCR decreased by 820.2 ± 1528.3 mg/g and UACR decreased by 606.4 ± 1119.6 mg/g. A ≥30% reduction in UPCR was achieved in 59.9% of patients. Greater reductions were observed in older patients, those with lower baseline potassium levels, and those receiving higher mean daily doses of finerenone.

Potassium levels increased by 0.3 mEq/L at 6 months. Treatment discontinuation due to hyperkalemia occurred in 5.4% of patients. The aldosterone-to-renin ratio decreased modestly at 3 months (−3.79 ± 13.76 ng/dL per ng/mL/h), with borderline statistical significance.

Finerenone use was associated with reduced proteinuria over 6 months, with a safety profile comparable to previous studies.