Kidney Week

Abstract: FR-PO0842

Eighteen-Month Effect of Finerenone in Patients with Type 2 Diabetes, CKD, and Nephrotic-Range Proteinuria

Session Information

• Glomerular Diseases: Practice and New Concepts Shaping Modern Care
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Zhou, Hua, Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

Hua Zhou, MD, PhD, FASN

• Qing, Liu, Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

Liu Qing, DM

• Luo, Xiaoling, Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

Xiaoling Luo, MS

• Yang, Honghao, Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

Honghao Yang, MS

• Luan, Junjun, Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

Junjun Luan, MD, PhD

Background

angiotensin II receptor blockers (ARB), sodium–glucose cotransporter 2 inhibitors (SGLT2i), and finerenone have shown benefits in patients with type 2 diabetes and chronic kidney disease (DKD), but the comparison of effects of between RASi plus SGLTi (dual therapy) and dual therapy plus finerenon (Triple therapy) remains limited. This study assessed triple therapy on renal outcomes and safety in Chinese patients including DKD patients with massive proteinuria.

Methods

DKD patients receiving ARB and SGLT2i treatment from March 2023 to May 2025 at Shengjing Hospital of China Medical University were prospectively assigned to dual therapy and triple therapy. All patients were followed for at least 6 months and extended the following time to 18months. The changes in 24-hour urine protein, estimated glomerular filtration rate (eGFR) based on CKD-EPI formula as well as safety and side effects were evaluated including subgroup analyses in patients with high urine albumin-to-creatinine ratio (UACR ≥ 5000 mg/g) or low eGFR (< 25 ml/min/1.73m²).

Results

99 subjects were enrolled, with 39 per group after propensity score matching. Compared with non-fenerenone dual therapy, the fenerenone triple therapy significantly reduced 24-hour urine protein from 1 month (mean [95% CI]: 6.21 [4.53, 8.50] vs. 3.36 [2.45, 4.60] g/24h; P = 0.007), up to 18 months (mean [95% CI]: 3.42[2.26, 4.89] vs. 1.69 [1.03, 2.51] g/24h; p=0.006), and eGFR remained stable. Among the subjects with UACR 〉 5000 mg/g, 24-hour urine protein decreased at 6 months (mean [95% CI]: 7.66 [4.78, 12.28] vs. 3.74 [2.33, 5.99] g/24h; P = 0.04). In patients with baseline eGFR < 25 ml/min/1.73m², 3 of 5 showed reductions in 24-hour urine protein and improvements in eGFR. No patients developed hyperkalemia requiring intervention.

Conclusion

The triple therapy (ARB, SGLT2i, and finerenone) further reduced proteinuria, maintained stable eGFR and was well tolerated, potentially benefiting DKD patients at different disease stages.

Funding

• Government Support – Non-U.S.