Finerenone Cuts Albuminuria Within Months in Diabetic Kidney Disease: FINE-TURK Study
Türkiye: Finerenone was associated with a substantial early reduction in albuminuria and a modest decline in estimated glomerular filtration rate (eGFR) among patients with diabetes and chronic kidney disease (CKD) receiving routine nephrology care, according to findings from the multicenter FINE-TURK study, published in BMC Nephrology by Serap Yadigar, Department of Nephrology, Doktor Lütfi Kırdar City Hospital, Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Türkiye, and colleagues.
Finerenone is a nonsteroidal mineralocorticoid receptor antagonist used to reduce kidney and cardiovascular risks in patients with diabetic CKD. However, information on the initial laboratory changes following its introduction into routine clinical practice remains limited, particularly among patients already receiving sodium-glucose cotransporter-2 (SGLT2) inhibitors.
The researchers conducted a multicenter, retrospective cohort study involving adults with diabetes and CKD who started finerenone during routine care. Laboratory measurements obtained before treatment and at the first available follow-up between 1 and 3 months were assessed. Changes in eGFR, serum potassium and urinary albumin-to-creatinine ratio (UACR) were evaluated, along with treatment persistence and early tolerability.
The analysis included 1,091 patients, with a mean age of 60.6 years and 55% being men. Background treatment with SGLT2 inhibitors was documented in 87% of 1,075 patients with available treatment data, indicating that most participants were receiving contemporary kidney-protective therapy.
The major findings were:
- Among 571 patients with paired eGFR measurements, median eGFR declined from 53.5 to 51.0 mL/min/1.73 m², corresponding to a median change of −2.0 mL/min/1.73 m².
- Serum potassium increased modestly, with median levels rising from 4.50 to 4.80 mEq/L.
- UACR decreased considerably, falling from a median of 777.8 to 461.2 mg/g among the 476 patients with paired measurements.
- 62.4% of patients with paired UACR data achieved at least a 30% reduction in albuminuria, while 38.7% achieved a reduction of at least 50%.
- Follow-up potassium levels above 5.5 mEq/L were recorded in 4.1% of patients, whereas levels above 6.0 mEq/L occurred in only 0.8%.
- Finerenone was discontinued in 39 patients (3.6%) during the observation period.
The investigators noted that the early eGFR decline was consistent with a transient hemodynamic effect that can occur after initiation of kidney-protective therapies, while the reduction in albuminuria was observed within the first few months of treatment.
However, the study was retrospective, lacked a comparison group and had incomplete follow-up laboratory data. Therefore, the findings cannot establish that finerenone directly caused the observed changes. The albuminuria analysis was also limited to patients who had measurements available at both time points, leaving the possibility of selection bias and regression toward the mean.
The researchers concluded that finerenone demonstrated early albuminuria reduction and generally manageable short-term laboratory changes, supporting its integration into treatment strategies for diabetic CKD, including settings where SGLT2 inhibitor use is already widespread.
Reference:
Yadigar, S., Akgür, S., Arslan, F. et al. Early laboratory trajectories and short-term tolerability after finerenone initiationin diabetic kidney disease: the multicenter FINE-TURK study. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-05259-4
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