Hyperkalemia risk with finerenone in diabetic kidney disease: a real-world analysis from the FINE-TURK cohort.
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Özdede Murat, Yadigar Serap, Güven Alper Tuna, Akgür Suat, Arslan Felemez, Sezen Mehmet, Özcan Büşra, Ayaz Elif Yıldırım, Doğantekin Betül, Atay İlker, Değer Serpil Müge, Demir Mustafa, Koyuncu Sümeyra, Yılmaz Üstün, İnci Ayça, Çolak Hülya, Demirelli Bülent, Tuğlular Serhan, Oguz Ebru Gok, Ayli Mehmet Deniz, Avanaz Ezgi, Yılmaz Fatih, Doğan Beyza, Karaköse Süleyman, Karakan Mine Şebnem, Demirci Bahar Gürlek, Türkmen Kültigin, Baloğlu İsmail, Batmazoğlu Mehmet, Mert Mehmet, Aydın Emre, Aydın Fatma Yılmaz, Parmaksız Ergün, Özdemir Pınar, Ediz Bartu, Aydın Zeki, Demir Mehmet Emin, Sezer Siren, Ünver Suat, Baykal Öznur, Akman Beril, Altuntaş Atila, İslam Mahmud, Koçak Sibel Yücel, Mert Meral, Dursun Belda, Eren Necmi, Demir Simge Bardak, Bilgiç Mukadder Ayşe, Erdut Arda, Keskin Gülşah, Horoz Mehmet, Şahin Ahmet Ziya, Tekinyıldız Merve, Duranay Murat, Yalın Serkan Feyyaz, Umut Hazal Melike Yavuz, Altunok Murat, Sarı Ramazan, Sarı Funda, Torun Dilek, Kahvecioğlu Serdar, Karatutlu Asena Serap, Akagün Tülin, Çelik Hüseyin, Kazan Sinan, Öztürk İlyas, Polat Mehmet, Aydın Mehmet Fethullah, Meşe Meral, Demirezen Asil, Derici Ülver, Altun Eda, Bakırdöğen Serkan, Kara Ekrem, Akgöl Cüneyt, Aykent Mahmut Başar, İlter Ali, Ekmekci Ahmet, Ulu Sena, Arıcı Mustafa, Şengül Erkan, Bakır Elif Arı
Аннотация
METHODOLOGY: FINE-TURK is a national, observational cohort of DKD patients who were initiated on finerenone. Eligible adults were included; demographic, clinical, and laboratory data were evaluated. The primary outcome was hyperkalemia risk signal (potassium ≥5.0 mEq/l), and the secondary outcome was clinically meaningful hyperkalemia (potassium ≥5.5 mEq/l) within 3 months. Multivariate logistic regression (LR) was used to define features associated with the both outcomes. Machine learning methods of LR, random forest (RF), extreme gradient boosting, and categorical boosting classifiers were used to define important features associated with the primary outcome.
RESULTS: Total 699 patients were included. Of them, 259 (37.1%) reached the primary outcome, and 51 (7.3%) reached the secondary outcome. Baseline serum potassium, estimated glomerular filtration rate (eGFR), and finerenone dose were associated with the both outcomes in multivariate LR. Machine learning analyses consistently identified baseline serum potassium and eGFR as the most influential factors associated with primary outcome, with thiazide use being associated with lower risk and 20 mg (compared to 10 mg) finerenone initiation being associated with higher risk. LR demonstrated the highest recall; RF achieved the highest precision in performance.
DISCUSSION: Real-world data suggest that the risk of clinically meaningful hyperkalemia is similar to that in the clinical trials. In parallel with the safety analysis of clinical trials, baseline potassium and eGFR were consistently the most important factors associated with hyperkalemia risk.