Serap Yadigar, Suat Akgür, Tolga Sinan Güvenç, 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 Demirci, 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, Ahmet Ziya Şahin, Mehmet Horoz, Merve Tekinyıldız, Murat Duranay, Serkan Feyyaz Yalın, Murat Altunok, Funda Sarı, Ramazan Sarı, Dilek Torun, Serdar Kahvecioğlu, A Serap Yalçınkaya, Tülin Akagün, Hüseyin Çelik, Sinan Kazan, İlyas Öztürk, Mehmet Polat, Mehmet Fethullah Aydın, Meral Meşe, Melike Hazal Yavuz Umut, Asil Demirezen, Ülver Derici, Eda Altun, Erkan Şengül, Serkan Bakırdöğen, Ekrem Kara, Cüneyt Akgöl, Mahmut Başar Aykent, Ali İlter, Ahmet Ekmekçi, Sena Ulu, Mustafa Arıcı, Elif Arı Bakır
In this nationwide real-world registry, patients with heart failure who were treated with finerenone had a higher-risk baseline profile, including older age and lower eGFR. Despite this, finerenone was not associated with increased short-term renal safety concerns and was linked to a clinically meaningful reduction in albuminuria. These findings support the short-term renal safety and potential efficacy of finerenone in patients with type 2 diabetes, kidney disease, and heart failure.
BACKGROUND: Finerenone, a non-steroidal mineralocorticoid receptor antagonist, improves cardiorenal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease. However, real-world data on its use in patients with concomitant heart failure remain limited. This study aimed to evaluate the baseline characteristics and short-term renal safety and efficacy of finerenone in patients with type 2 diabetes, kidney disease, and heart failure from the FINE-TURK Registry.
METHODS: This was a retrospective, multicenter, observational registry analysis conducted across 56 centers in Türkiye. Among 1,168 patients initially enrolled, 918 patients with available heart failure status and ejection fraction data were included. Patients were categorized according to the presence of heart failure, and heart failure patients were further classified as HFrEF or HFmrEF/HFpEF. Three-month changes in serum potassium, estimated glomerular filtration rate, and albuminuria were assessed. Safety endpoints included serum potassium ≥ 5.5 mEq/L and eGFR ≤ 25 mL/min/1.73 m² at three months. The primary renal efficacy endpoint was a > 30% reduction in albuminuria from baseline.
RESULTS: Of 918 patients, 133 had heart failure. Patients with heart failure were older and had lower baseline eGFR compared with those without heart failure. They were also more likely to receive a lower starting dose of finerenone. At three months, changes in serum potassium, eGFR, and albuminuria were not significantly different between patients with and without heart failure. No excess risk of hyperkalemia or worsening renal function was observed in the heart failure group. In adjusted analyses, heart failure was associated with a greater likelihood of achieving a > 30% reduction in albuminuria. No significant differences in short-term renal safety or efficacy outcomes were observed between HFrEF and HFmrEF/HFpEF subgroups.
CONCLUSIONS: In this nationwide real-world registry, patients with heart failure who were treated with finerenone had a higher-risk baseline profile, including older age and lower eGFR. Despite this, finerenone was not associated with increased short-term renal safety concerns and was linked to a clinically meaningful reduction in albuminuria. These findings support the short-term renal safety and potential efficacy of finerenone in patients with type 2 diabetes, kidney disease, and heart failure.