Twenty-Four-Week UACR Response Trajectories and Clinical Correlates of Residual Albuminuria in Diabetic Kidney Disease During Finerenone Therapy: A Real-World Longitudinal Study.

BACKGROUND

After finerenone therapy, some patients with diabetic kidney disease (DKD) continue to have residual albuminuria. A single time-point change in urinary albumin-to-creatinine ratio (UACR) may not fully capture response heterogeneity in real-world practice. This study aimed to identify 24-week baseline-corrected UACR response trajectories in patients with DKD and residual albuminuria during finerenone therapy and to examine associated clinical factors.

METHODS

This single-center retrospective real-world longitudinal cohort study included 136 patients with DKD who had residual albuminuria after at least 4 weeks of finerenone therapy and available longitudinal UACR data. Based on multi-time-point log(UACR_t/UACR_baseline) data over 24 weeks, latent class mixed models were used to identify UACR response trajectories and analyze clinical factors associated with the persistent residual albuminuria trajectory.

RESULTS

Three UACR response trajectories were identified: favorable response in 43 patients (31.6%), partial response in 62 patients (45.6%), and persistent residual albuminuria in 31 patients (22.8%); the latter 2 patterns accounted for 68.4% of the selected residual-albuminuria cohort. The median relative changes in UACR at week 24 were -51.6%, -24.8%, and -4.9%, respectively. Higher HbA1c was associated with higher estimated odds of the persistent residual albuminuria trajectory (OR, 1.46; 95% CI, 1.07-2.00). The estimated directions for systolic blood pressure and sodium-glucose cotransporter 2 (SGLT2) inhibitor use were consistent, although uncertainty remained in extended or selected sensitivity analyses. Week-24 eGFR changes did not differ clearly across trajectories, and continuous UACR change was not clearly associated with eGFR change.

CONCLUSION

Patients with DKD and residual albuminuria during finerenone therapy showed distinct 24-week UACR response trajectories. Trajectory analysis provides exploratory real-world evidence for dynamic risk stratification, but the identified patterns and clinical correlates require validation in larger, prospective, multicenter cohorts with longer follow-up.