Antiproteinuric response to finerenone in diabetic kidney disease: analysis of responders and non-responders in the Latin American FINDKDLATAM cohort.

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) is the leading cause of chronic kidney disease (CKD). Albuminuria is a marker of kidney damage, and its reduction is a therapeutic goal. Finerenone has demonstrated cardiorenal benefits in patients with CKD associated with T2DM; however, there is variability in the magnitude of the antiproteinuric response. Objective: To describe the clinical profile associated with a greater antiproteinuric response to finerenone in patients with CKD associated with T2DM by analyzing responders and non-responders from the FINDKDLATAM cohort.

Materials and Methods: A subgroup analysis including patients with CKD associated with T2DM from seven countries. Patients were classified as absolute responders (≥50% reduction in UACR), partial responders (30% to 49% reduction), and non-responders (<30% reduction) at the 6-month follow-up. Sociodemographic, clinical, biochemical, and therapeutic variables, as well as safety data, were analyzed.

Results: Of the 347 patients in the original cohort, 334 had complete data. 80.2% (n = 268) were absolute responders, 11.7% (n = 39) were partial responders, and 8.1% (n = 27) were non-responders. Among absolute responders, UACR decreased from 350.7 mg/g to 67.0 mg/g, an 81.4% reduction (p < 0.0001). Among partial responders, UACR fell from 240.5 mg/g to 143.0 mg/g, a 40.5% reduction (p < 0.0001). No significant changes were observed in non-responders. eGFR remained stable in responders, whereas a significant decline was observed in non-responders. A modest increase in serum potassium was observed, without reaching clinically relevant levels of hyperkalemia. The combination of finerenone and SGLT2 inhibitors showed the highest proportion of absolute responders (98.6%).

Conclusions: In this Latin American cohort of patients with diabetic kidney disease (DKD), 90% demonstrated a positive antiproteinuric response and a favorable safety profile, regardless of baseline clinical characteristics. No specific clinical profile associated with a higher likelihood of response was identified, suggesting that the antiproteinuric benefit of finerenone may be observed across a broad spectrum of patients with diabetic kidney disease.