Real-World Effectiveness and Safety of Finerenone in People With Type 2 Diabetes and Chronic Kidney Disease: A Spanish Multicentre Retrospective Observational Study (MEDFINE-RWD).

AIM: Although finerenone has shown efficacy in randomized trials, evidence from routine clinical practice remains limited. We aimed to assess the real-world effectiveness and safety of finerenone in people with type 2 diabetes (PWT2D) and chronic kidney disease (CKD), with a particular focus on residual cardiorenal risk as reflected by changes in urinary albumin-to-creatinine ratio (UACR).

MATERIALS AND

METHODS

MEDFINE-RWD was a multicentre, retrospective study across eight Spanish centres, enrolling patients initiating finerenone (June 2024-December 2025). The primary endpoint was a ≥ 30% reduction in UACR. Multivariable logistic regression identified response predictors. Secondary outcomes included safety (hyperkalaemia ≥ 5.5 mmol/L, major kidney [MAKE] and cardiovascular events [MACE]).

RESULTS

Among 844 participants (median age 72 years; median follow-up 184 days; 76.8% male; baseline eGFR 49 mL/min/1.73 m2; UACR 285 mg/g; 77.8% were at high/very high KDIGO risk), finerenone was associated with a 34.5% median UACR reduction at 6 months (p < 0.001), despite intensive SGLT2 inhibitors (88.4%) and GLP-1 receptor agonists (35.7%) use. The primary endpoint was achieved by 52.7%, consistently across background renoprotection or baseline KDIGO risk strata. Predictors of response were age ≥ 70 (aOR 2.12), baseline UACR > 245 mg/g (aOR 1.94), and BMI > 27 kg/m2 (aOR 1.84), while insulin use was associated with lower response odds. Treatment persistence was 89.5%, with low incidences of hyperkalaemia (4.8%), MAKE (0.9%), and MACE (1.1%).

CONCLUSIONS

In real-world practice, finerenone was associated with a substantial reduction in albuminuria. Finerenone demonstrated high persistence and a favourable safety profile, irrespective of baseline renoprotective regimens or KDIGO risk.