Abstract: TH-PO0378
Finerenone Use in Patients with Diabetes and CKD
Session Information
- Diabetic Kidney Disease: From Early Biomarkers to Novel Therapeutic Targets
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Lin, Wei, Johns Hopkins University, Baltimore, Maryland, United States
- Schweber, Adam, New York University, New York, New York, United States
- Xu, Yunwen, Johns Hopkins University, Baltimore, Maryland, United States
- Chang, Alexander R., Geisinger Health, Danville, Pennsylvania, United States
- Farag, Youssef MK, Alexion Pharmaceuticals Inc, Boston, Massachusetts, United States
- Grams, Morgan, New York University, New York, New York, United States
- Shin, Jung-Im, Johns Hopkins University, Baltimore, Maryland, United States
Background
Nonsteroidal mineralocorticoid receptor antagonist (ns-MRA) is a guideline-recommended therapy (GDMT) for patients with type 2 diabetes and CKD. Finerenone is the only medication in this class with proven cardiorenal benefits. Little is known about the adoption of finerenone in clinical practice.
Methods
We analyzed medication data from July 9, 2021 (finerenone approval date) in three US health systems. We estimated finerenone initiation rates and compared baseline CKD progression risk between finerenone initiators and other cardiovascular medication initiators in diabetes. We quantified a proportion of finerenone initiation among eligible individuals (diabetes and CKD with eGFR ≥25 ml/min/1.73 m2 and ACR ≥30 mg/g). Independent factors associated with finerenone initiation were assessed using multivariable logistic regression in each system and summarized by random-effects meta-analysis.
Results
In each health system, finerenone initiation significantly increased at a quarterly rate of 15.6% (95% CI: 10.3% - 21.0%), 19.2% (8.5% - 30.9%) and 15.9% (6.8% - 25.7%), respectively. Finerenone was more commonly used in patients with higher risk for CKD progression at baseline (Figure 1). However, among eligible patients, finerenone initiation rates were 1.32%, 0.20% and 0.24% across three health systems. Among finerenone eligible patients, the strongest factors associated with finerenone initiation were ACR ≥300 mg/g (meta-analyzed aOR=3.91, 95% CI [2.47, 6.19]), eGFR of 25-45 ml/min/1.73m2 (3.30 [2.24, 4.84]) and having ≥2 concomitant GDMTs (RASi, SGLT2i, or GLP-1RA) (3.87 [2.97, 4.91]), consistent across three systems.
Conclusion
Finerenone initiation increased over time and was targeted toward patients with higher CKD progression risk. However, extremely low fractions of eligible patients received finerenone. Key determinants of initiation included severe albuminuria, lower eGFR and a receipt of multiple GDMT. Efforts are needed to increase finerenone use in patients with diabetes and CKD.
Distribution of CKD progression risk at baseline among finerenone vs. other medication initiators in diabetes
Funding
- Commercial Support – Bayer