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Publications

Journal Article Multicenter Study Epublish

PubMed: 42693414 DOI: 10.1186/s12882-026-05259-4

Early laboratory trajectories and short-term tolerability after finerenone initiationin diabetic kidney disease: the multicenter FINE-TURK study.

BMC Nephrol 27(1)

Authors: Serap Yadigar, Suat Akgür, Felemez Arslan, Mehmet Sezen, Büşra Özcan, Elif Yıldırım Ayaz, Betül Doğantekin, İlker Atay, Serpil Müge Değer, Mustafa Demir, Sümeyra Koyuncu, Üstün Yılmaz, Ayça İnci, Hülya Çolak, Bülent Demirelli, Serhan Tuğlular, Ebru Gök Oğuz, Mehmet Deniz Aylı, Ezgi Avanaz, Fatih Yılmaz, Beyza Doğan, Süleyman Karaköse, Mine Şebnem Karakan, Bahar Gürlek, Kültigin Türkmen, İsmail Baloğlu, Mehmet Batmazoğlu, Mehmet Mert, Emre Aydın, Fatma Yılmaz Aydın, Ergün Parmaksız, Pınar Özdemir, Bartu Ediz, Zeki Aydın, Mehmet Emin Demir, Siren Sezer, Suat Ünver, Öznur Baykal, Beril Akman Çakmak, Atila Altuntaş, Mahmud İslam, Fatma Sibel Koçak Yücel, Meral Mert, Belda Dursun, Necmi Eren, Simge Bardak Demir, Alper Tuna Güven, Mukadder Ayşe Bilgiç, Arda Erdut, Gülşah Keskin … and 33 other authors

Affiliations

  • Department of Nephrology, Doktor Lütfi Kırdar City Hospital, Hamidiye International School of Medicine, University of Health Sciences, D-100 Güney Yanyol No: 47 Cevizli Mevkii, Kartal, Istanbul, 34865, Türkiye.
  • Department of Nephrology, Bursa City Hospital, University of Health Sciences, Bursa, Türkiye.
  • Clinical of Internal Medicine, Bakırköy Sadi Konuk Training and Research Hospital, University of Health Sciences Turkiye, Istanbul, Türkiye.
  • Division of Endocrinology and Metabolism, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Türkiye.
  • Department of Internal Medicine, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Kadıköy, Türkiye.
  • Division of Nephrology, School of Medicine, Dokuz Eylül University, İzmir, Türkiye.
  • Nephrology Clinic, Kayseri City Hospital, Health Sciences University, Kayseri, Türkiye.
  • Nephrology Clinic, Antalya Training and Research Hospital, Health Sciences University, Antalya, Türkiye.
  • Nephrology Clinic, İzmir City Hospital, Health Sciences University, İzmir, Türkiye.
  • Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Türkiye.
  • Department of Nephrology, Etlik City Hospital, University of Health Sciences, Ankara, Türkiye.
  • Department of Nephrology, Antalya City Hospital, Health Sciences University, Antalya, Türkiye.
  • Nephrology Clinic, Konya City Hospital, Health Sciences University, Konya, Türkiye.
  • Department of Nephrology, Ankara Yıldırım Beyazıt University, Ankara, Türkiye.
  • Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye.
  • Department of Nephrology, Denizli State Hospital, Denizli, Türkiye.
  • Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakır, Türkiye.
  • Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Türkiye.
  • Department of Nephrology, Doktor Lütfi Kırdar City Hospital, Hamidiye International School of Medicine, University of Health Sciences, D-100 Güney Yanyol No: 47 Cevizli Mevkii, Kartal, Istanbul, 34865, Türkiye.
  • Department of Nephrology, Darıca Farabi Training and Research Hospital, University of Health Sciences, Kocaeli, Türkiye.
  • Department of Nephrology, Internal Medicine and Organ Transplantation, School of Medicine, Medicana International Ankara Hospital, Atılım University, Ankara, Türkiye.
  • Department of Internal Medicine and Nephrology, Acıbadem Hospital, Istanbul, Türkiye.
  • Department of Nephrology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye.
  • Department of Internal Medicine and Nephrology, Acıbadem Hospital, Ankara, Türkiye.
  • Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Türkiye.
  • Department of Nephrology, School of Medicine, Sakarya University, Sakarya, Türkiye.
  • Department of Nephrology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Türkiye.
  • Department of Endocrinology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Türkiye.
  • Department of Nephrology, School of Medicine, Pamukkale University, Denizli, Türkiye.
  • Department of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye.
  • Department of Nephrology, Yenimahalle Education and Research Hospital, Ankara Yıldırım Beyazıt University, Ankara, Türkiye.
  • Division of General Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Başkent University, Ankara, Türkiye.
  • Department of Nephrology, Ankara Medical Park Hospital, Ankara, Türkiye.
  • Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
  • Division of Endocrinology and Metabolism, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye.

Abstract

BACKGROUND

Real-world evidence describing the early laboratory course after finerenone initiation in contemporary nephrology practice remains limited, particularly in cohorts with high background use of sodium-glucose co transporter 2 inhibitors (SGLT2i). We evaluated early kidney-function, potassium, and albuminuria trajectories and short-term treatment tolerability.

METHODS

FINE-TURK was a multicenter retrospective cohort study without a comparator group. Adults with diabetes and chronic kidney disease who initiated finerenone in routine care were evaluated at baseline and using the first available values recorded in the 1-3-month follow-up fields. Primary outcomes were within-patient changes in estimated glomerular filtration rate (eGFR), serum potassium, and urinary albumin-to-creatinine ratio (UACR). Complete and incomplete follow-up groups were compared, UACR responder analyses were performed, and exploratory multivariable and subgroup models were fitted.

RESULTS

The analytic cohort contained 1,091 patients (mean age 60.6 ± 11.5 years; 55.0% male), and documented SGLT2i use was 87.0% among 1,075 patients with available data. Paired data were available for eGFR in 571 patients (52.3%), potassium in 647 (59.3%), and UACR in 476 (43.6%). Median eGFR changed from 53.5 [41.0-74.5] to 51.0 [38.0-73.0] mL/min/1.73m² (median change -2.0 [-6.0 to 1.0]; P<0.001). Median potassium changed from 4.50 [4.20-4.80] to 4.80 [4.50-5.10] mEq/L (mean change +0.30 ± 0.46; P<0.001). Median UACR changed from 777.8 [327.2-1539.5] to 461.2 [154.7-1040.0] mg/g; 297/476 (62.4%, 95% CI 58.0-66.6) achieved a ≥30% reduction and 184/476 (38.7%, 95% CI 34.4-43.1) achieved a ≥50% reduction. A recorded follow-up potassium >5.5 mEq/L occurred in 27/653 (4.1%), >6.0 mEq/L in 5/653 (0.8%), and finerenone discontinuation in 39/1,091 (3.6%).

CONCLUSIONS

Early laboratory changes and treatment persistence after finerenone initiation were describable in routine specialist care, but incomplete outcome ascertainment and the absence of a comparator group preclude causal or comparative-effectiveness conclusions. The albuminuria findings apply only to patients with paired measurements and remain vulnerable to selection bias and regression to the mean.

MeSH

Kidney Diseases, Laboratories, Diabetic Nephropathies, Albuminuria, Kidney, Therapeutics