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, Ahmet Ziya Şahin, Mehmet Horoz, Merve Tekinyıldız, Murat Durunay, 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, Serkan Bakırdöğen, Ekrem Kara, Cüneyt Akgöl, Mahmut Başar Aykent, Ali İlter, Ahmet Ekmekçi, Sena Ulu, Bilge Özlüer Başer, Mustafa Arıcı, Elif Arı Bakır, Erkan Şengül
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.
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.