Diabetes, obesity & metabolism · 2026
Trajectories of Albuminuria and Non-Albumin Proteinuria After Sequential Addition of Finerenone for Residual Albuminuria Despite Established SGLT2 Inhibitor Therapy in Diabetic Kidney Disease: A Real-World Cohort Study.
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Choi Min Seo, Yu Minheui, Kim Hyung Woo, Lee Minyoung, Lee Yong-Ho, Kang Eun Seok, Cha Bong-Soo, Lee Byung-Wan
Аннотация
AIMS: CONFIDENCE evaluated simultaneous initiation of finerenone and an SGLT2 inhibitor (SGLT2i). We examined 12-month trajectories of albuminuria and non-albumin proteinuria after finerenone was added to established SGLT2i therapy.
MATERIALS AND METHODS: This single-centre retrospective cohort study included 86 patients with type 2 diabetes treated with finerenone after SGLT2i therapy. Urinary albumin-to-creatinine ratio (UACR), protein-to-creatinine ratio (UPCR) and non-albumin protein-to-creatinine ratio (UNAPCR) were measured before SGLT2i initiation (T1) and finerenone initiation (T2), at the first post-finerenone assessment (median 1.6 months), and at 6 and 12 months. Covariate-adjusted linear mixed-effects models of log-transformed markers estimated geometric mean changes from T2, with Holm adjustment across 12 primary contrasts.
RESULTS: Urinary markers showed no significant net changes between T1 and T2. After finerenone initiation, UACR decreased by 46.2% at the first post-finerenone assessment and remained 35.2% lower at 12 months (95% confidence interval [CI], -47.1 to -20.7); corresponding reductions were 39.9% and 23.1% for UPCR and 33.7% and 13.6% for UNAPCR. All reductions were significant except for UNAPCR at 12 months (adjusted p = 0.16). At 12 months, 39 of 76 patients (51.3%) achieved a UACR reduction ≥ 30%. Mean serum potassium level increased from 4.6 to 4.8 mmol/L and plateaued; levels > 5.5 and > 6.0 mmol/L occurred in 17.4% and 4.7% of patients, respectively.
CONCLUSIONS: In patients with residual albuminuria despite established SGLT2i therapy, finerenone addition was associated with sustained 12-month reductions in albuminuria and total proteinuria and an early reduction in non-albumin proteinuria that attenuated by 12 months. Prospective confirmation is warranted.
MATERIALS AND METHODS: This single-centre retrospective cohort study included 86 patients with type 2 diabetes treated with finerenone after SGLT2i therapy. Urinary albumin-to-creatinine ratio (UACR), protein-to-creatinine ratio (UPCR) and non-albumin protein-to-creatinine ratio (UNAPCR) were measured before SGLT2i initiation (T1) and finerenone initiation (T2), at the first post-finerenone assessment (median 1.6 months), and at 6 and 12 months. Covariate-adjusted linear mixed-effects models of log-transformed markers estimated geometric mean changes from T2, with Holm adjustment across 12 primary contrasts.
RESULTS: Urinary markers showed no significant net changes between T1 and T2. After finerenone initiation, UACR decreased by 46.2% at the first post-finerenone assessment and remained 35.2% lower at 12 months (95% confidence interval [CI], -47.1 to -20.7); corresponding reductions were 39.9% and 23.1% for UPCR and 33.7% and 13.6% for UNAPCR. All reductions were significant except for UNAPCR at 12 months (adjusted p = 0.16). At 12 months, 39 of 76 patients (51.3%) achieved a UACR reduction ≥ 30%. Mean serum potassium level increased from 4.6 to 4.8 mmol/L and plateaued; levels > 5.5 and > 6.0 mmol/L occurred in 17.4% and 4.7% of patients, respectively.
CONCLUSIONS: In patients with residual albuminuria despite established SGLT2i therapy, finerenone addition was associated with sustained 12-month reductions in albuminuria and total proteinuria and an early reduction in non-albumin proteinuria that attenuated by 12 months. Prospective confirmation is warranted.