Efficacy of Finerenone in Slowing the Progression of Chronic Kidney Disease in Type 2 Diabetes.

Abstract

Objective: To evaluate short-term effects and safety of Finerenone in clinical practice of nephrology.
Methodology: A prospective observational study was done at the Department of Nephrology, Shaikh Zayed Hospital, Lahore, Pakistan from 01 September 2025 to 30 March 2026. 100 adults (18-80 years) with type 2 diabetes and chronic kidney disease (CKD) (eGFR ≥ 25 mL/min/1.73 m², Urine Albumin-Creatinine Ratio (UACR) ≥ 30 mg/g), who were on stable ACE inhibitor/ARB therapy, were consecutively enrolled, with baseline potassium levels of ≤ 4.8 mmoL/L. Follow-up visits were conducted after 1 and 3 months. Paired t-tests and Wilcoxon signed-rank tests were used to test the changes from baseline for continuous variables and UACR, respectively, at p<0.05.
Results: The mean age was 64.8±8.0 years and 70% of the population was male. Baseline eGFR was 45.0±10.7 mL/min/1.73 m² and median UACR was 800 mg/g [IQR 330–1643]. At 1 month, 95% and 3 month, 92% of the children were attending. UACR decreased to 607 [272–1277] at 1 month and 540 [244–1142] at 3 months (both p<0.001). Mean eGFR declined to 43.9±11.2 at 1 month and 41.9±11.8 at 3 months (both p<0.001). Mean potassium increased from 4.35±0.24 to 4.56±0.47 at 1 month (p<0.001) and 4.47±0.43 at 3 months (p=0.004); potassium >5.5 mmol/L occurred in 5.3% and 2.2%, respectively. The combined outcome of kidney was seen in 7% and hyperkalaemia requiring ER/hospitalization occurred in 2% in 3 months.
Conclusion: Finerenone was associated with early albuminuria reduction and acceptable short-term safety with potas-sium monitoring.
Keywords: Albuminuria; Chronic kidney disease; Finerenone; Hyperkalaemia; Type 2 diabetes mellitus.