Effect of the non-steroidal mineralocorticoid receptor antagonist finerenone on renal function parameters in patients with type 2 diabetes mellitus and chronic kidney disease

Diabetic kidney disease (DKD) is a major complication of type 2 diabetes mellitus (T2DM) and significantly increases the risk of chronic kidney disease (CKD) progression, cardiovascular events, and mortality. Despite established therapies such as renin–angiotensin–aldosterone system blockade and sodium–glucose co-transporter 2 inhibitors, additional nephroprotective interventions are required. Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist (MRA), demonstrated cardio-renal benefits in large randomized trials. However, evidence on its short-term effectiveness across different CKD stages in routine clinical practice remains limited. Objective — to evaluate the effect of finerenone on renal function parameters in patients with T2DMM and DKD depending on the stage of CKD. Materials and methods. A prospective study enrolled 45 adults with T2DM and DKD who received finerenone 10 or 20 mg daily. Patients were stratified by CKD stage (I—IV) according to KDIGO 2021. The follow-up period was 3 months. Kidney function was assessed using urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), blood pressure, serum potassium levels, and treatment-related adverse events. Statistical significance was set at p < 0.05. Results. Finerenone resulted in a clinically meaningful improvement in kidney injury markers. After 3 months, UACR decreased by 27% in the overall cohort (p < 0.01). Patients with CKD stages II—III demonstrated the most pronounced reduction in albuminuria, reaching 34% (p < 0.01), whereas patients with stage IV exhibited a smaller but still beneficial response. eGFR remained stable across all CKD stages, indicating a slowing of kidney function decline. Serum potassium levels did not show clinically meaningful elevation, and no patient discontinued treatment due to adverse events. Conclusions. Finerenone reduces albuminuria and helps preserve kidney function in patients with T2DM and DKD, with the greatest benefit observed in CKD stages II—III. The favorable safety profile of finerenone supports its early initiation as part of a personalized approach to DKD management.