Abstract: TH-PO0383
Safety and Feasibility of Simultaneous and Gradual Initiation of Combination Renoprotective Therapy in Patients with Type 2 Diabetes and CKD: A Real-World Analysis
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
- Antonic, Manja, General Hospital Trbovlje, Trbovlje, Slovenia
- Leskovar, Bostjan, General Hospital Trbovlje, Trbovlje, Slovenia
- Fornazarič, Denis, University Medical Center Ljubljana, Ljubljana, Slovenia
Background
While gradual initiation of combination renoprotective therapy for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) is commonly employed, evidence on the simultaneous initiation of combination therapy is limited. This study aimed to assess the safety and feasibility of both strategies in real-world practice.
Methods
In this retrospective study, 40 patients (mean age 71±7 years; 26 males) with T2D and CKD received either gradual (n=31) or simultaneous (n=9) initiation of SGLT-2 inhibitors and finerenone. Background use of RAS inhibitors and/or GLP-1 RA was allowed. Safety endpoints included serum potassium, eGFR, and adverse events. Only patients completing therapy during follow-up were analyzed.
Results
Of the 31 patients in the gradual group, five (16%) discontinued due to adverse effects and were excluded. The final analysis included 26 patients from the gradual group (median follow-up: 21 months) and 9 from the simultaneous group (median follow-up: 3 months). Both treatments were well-tolerated—one patient in the gradual group reported mild pruritus, and no adverse events occurred in the simultaneous group. In the gradual group, potassium levels increased significantly after finerenone initiation (from 4.3±0.5 to 4.6±0.6 mmol/L, p=0.004), stabilizing over time. In the simultaneous group, potassium rose continuously throughout follow-up (from 4.6±0.6 to 4.9±0.3 mmol/L, p=0.042) without reaching stabilization. Potassium levels remained within clinically acceptable limits in both groups. A non-significant trend toward eGFR decline was observed in the simultaneous group (from 37±24 to 32±23 mL/min/1.73 m2; p=0.225), while a significant decline of eGFR was noted in the gradual group (from 47±20 to 44±21 mL/min/1.73 m2; p=0.01), with no severe renal deterioration.
Conclusion
Simultaneous initiation of combination therapy was well-tolerated, with fewer adverse effects despite lower baseline eGFR, though shorter follow-up may have limited event detection. In contrast, the longer treatment duration in the gradual group appeared to support better potassium stabilization. These real-world findings support the feasibility of both approaches, although further studies are needed to assess long-term outcomes of simultaneous initiation.