Real-World Effects of Finerenone in Diabetics Kidney Disease: Data From Fine-Turk Study

Abstract Background: Randomized trials have established the benefits of finerenone in type 2 diabetes with CKD; however, real-world evidence with high SGLT2 inhibitor uptake remains limited. Methods: FINE-TURK was a multicenter retrospective cohort study conducted at 56 nephrology centers in Turkey. Adults with type 2 diabetes and CKD initiating finerenone (January 2025 to June 2025) were assessed at baseline, month 1, and month 3. Primary endpoints were changes in estimated glomerular filtration rate (eGFR), serum potassium, and urinary albumin-to-creatinine ratio (UACR); hyperkalemia was defined as potassium >5.5 mEq/L. Results: Among 1,091 patients (60.6±11.5 years, 55% male), 87% received an SGLT2 inhibitor and 100% renin-angiotensin system blockade. Finerenone started at 10 mg in 85%. Paired analyses included 576 for eGFR, 648 for potassium, and 487 for UACR. Mean eGFR fell from 58.51±24.20 to 55.78±23.19 mL/min/1.73 m2 at month 1 and remained 55.78±23.13 at month 3 (both P<0.001 vs baseline). Mean potassium increased from 4.49±0.39 to 4.75±0.47 and 4.78±0.44 mEq/L (P<0.001). Median UACR declined from 690.6 (271.4-1538.0) mg/g to 468.0 (173.5-1195.5) at month 1 and 450.0 (154.5-1041.0) mg/g at month 3, corresponding to 32.2% and 34.8% reductions (P<0.001). Hyperkalemia occurred in 5.0% at both visits, commonly managed with potassium binders; hospitalizations were infrequent (2.8% and 3.1%), and no deaths occurred. Conclusions: In routine care with high SGLT2 inhibitor uptake, finerenone achieved a rapid reduction in albuminuria, with a modest early decline in eGFR, manageable potassium elevations, and low short-term event rates, supporting early use alongside standard therapy in contemporary clinical practice.