Experience of using fi nerenon in patients with diabetes mellitus, various stages of chronic kidney disease

BACKGROUND. Chronic kidney disease (CKD) is a persistent disorder of kidney structure or function lasting more than three months, with diabetes mellitus being one of its leading causes worldwide. Since 2023, finerenone a nonsteroidal mineralocorticoid receptor antagonist (MRA) has been approved in the Russian Federation. Preclinical and clinical studies have demonstrated its anti-inflammatory and antifibrotic effects, positioning finerenone as a promising treatment for patients with type 2 diabetes mellitus (T2DM) and CKD. While initial data from scientific literature show encouraging results, further research is needed to better understand its mechanism of action and evaluate long-term outcomes. 

THE AIM: to evaluation of the efficacy and safety of finerenone in patients with type 2 diabetes mellitus and chronic kidney disease. 

PATIENTS AND METHODS . As part of a clinical observation study, 25 patients with comorbid type 2 diabetes mellitus and chronic kidney disease were evaluated. All participants underwent comprehensive testing, including the assessments of biochemical parameters of kidney function, carbohydrate metabolism and lipid profile. Finerenone was used as an adjunctive therapy. A follow-up evaluation was performed after 6 months of therapy. Statistical analysis was performed using specialized software employing parametric or nonparametric methods, depending on the nature of the data distribution. The critical significance level of p < 0.05. 

RESULTS. The study included 25 patients with type 2 diabetes mellitus and chronic kidney disease (mean age 60.28 ± 6.90 years, comprising 15 were men (60 %) and 10 were women (40 %). After six months of finerenone therapy, significant reductions in albuminuria (219→158 mg/g, p<0.001) and improvements in GFR (56.2→59.8 ml/min, p<0.001) were observed. Normalization of albuminuria was registered in 12 % of patients. Regarding the safety of use, a decrease in cardiovascular risk was noted 32 % to 16 %. 

CONCLUSIONS. In patients with diabetic nephropathy, finerenone demonstrates significant nephroprotective effects, as evidenced by redused in albuminuria (p<0.0001) and improved glomerular filtration rates. The drug also exhibits a favorable safety profile with no clinically significant impact on electrolyte balance (p<0.05). Of particular interest is the demonstrated decrease in the proportion of patients at high cardiovascular risk (from 32 % to 16 %). These findings support the inclusion of finerenone in combination therapy regimens for diabetic kidney disease.

1. Dedov II, Shestakova MV, Sukhareva OY et al. Algorithms for specialized medical care for patients with diabetes mellitus. Dedov II, Shestakova MV, Sukhareva OY, eds. 12th issue. M., 2025; 247 p. (In Russ.)

2. Krishnan A, Teixeira-Pinto A, Lim WH et al. Health-Related Quality of Life in People Across the Spectrum of CKD. Kidney Int Rep 2020;5(12):2264–2274. doi: 10.1016/j.ekir.2020.09.028

3. Bello A, Alrukhaimi M, Ashuntantang G, Basnet S et al. Complications of chronic kidney disease: current state, knowledge gaps, and strategy for action. Kidney Int Suppl 2017;7(2):122–129. doi: 10.1016/j.kisu.2017.07.007

4. Nayak-Rao S, Shenoy MP. Stroke in Patients with Chronic Kidney Disease: How do we Approach and Manage it? Indian J Nephrol 2017;27(3):167–171. doi:10.4103/0971-4065.20240

5. Vaidya SR, Aeddula NR. Chronic Kidney Disease. StatPearls Publishing; 2025

6. Fox CS, Matsushita K, Woodward M. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet 2012:380(9854):1662–1673. doi:10.1016/S0140-6736(12) 61350-6

7. Jankowski J, Floege J, Fliser D et al. Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options. Circulation 2021;143(11):1157–1172. doi: 10.1161/CIRCULATIONAHA.120.050686

8. Hashmi MF, Benjamin O, Lappin SL. End-Stage Renal Disease. StatPearls Publishing; 2025

9. Lysenko YuS, Mikita OYu, Pinchuk AV, Khubutiya MSh. Economic consequences of noncompliant behavior of patients with chronic renal failure and ways of its correction. Transplantologiya. The Russian Journal of Transplantation 2022;14(3):278–291. (In Russ.) doi: 10.23873/2074-0506-2022-14-3-278-291

10. Yang F, Liao M, Wang P et al. The Cost-Effectiveness of Kidney Replacement Therapy Modalities: A Systematic Review of Full Economic Evaluations. App Health Econ Health Policy 2021;19(2):163–180. doi: 10.1007/s40258-020-00614-4

11. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2022. 15th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs 2023;25(3): 8–30. (In Russ.) doi:10.15825/1995-1191-2023-3-8-30

12. Chaudhry K, Karalliedde J. Chronic kidney disease in type 2 diabetes: The size of the problem, addressing residual renal risk and what we have learned from the CREDENCE trial. Diabetes Obes Metab 2024;26(5):25–34. doi: 10.1111/dom.15765

13. Shamkhalova MS, Vikulova OK, Zheleznyakova AV et al. Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022). Diabetes mellitus 2023;26(5):404–417. (In Russ.) doi: 10.14341/DM13090

14. Christofides EA, Desai N. Optimal Early Diagnosis and Monitoring of Diabetic Kidney Disease in Type 2 Diabetes Mellitus: Addressing the Barriers to Albuminuria Testing. J Prim Care Community Health 2021;12. doi: 10.1177/21501327211003683

15. Shamkhalova MS, Sukhareva OY, Martynov SA et al. Chronic kidney disease in patients with diabetes mellitus: new challenges. Diabetes mellitus 2025;28(1):46–55. (In Russ.) doi: 10.14341/ DM13268

16. Triozzi JL, Parker GL, Virani SS, Navaneethan SD. Management of type 2 diabetes in chronic kidney disease. BMJ Open Diabetes Res Care 2021;9(1). doi: 10.1136/bmjdrc-2021-002300

17. Agarwal R, Kolkhof P, Bakris G et al. Steroidal and nonsteroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J 2021;42(2):152–161. doi: 10.1093/eurheartj/ehaa736

18. Khalimov YuSh, Semikova GV, Shutova YuA. Novel cardioprotective and nephroprotective combination in patients with type 2 diabetes and chronic kidney disease: perspectives of use. Diabetes mellitus 2024;27(1):93–103. (In Russ.) doi: 10.14341/DM13113

19. Shestakova MV, Dobronravov VA, Ametov AS. Prospects of finerenone use in Russian population of patients with chronic kidney disease and type 2 diabetes. Resolution of multidisciplinary. Advisory board. Diabetes mellitus 2023;26(5):492–499. (In Russ.) doi: 10.14341/DM13020

20. Rossing P, Burgess E, Agarwal R et al. Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes According to Baseline HbA1c and Insulin Use: An Analysis From the FIDELIO-DKD Study. Diabetes care 2022;45(4):888–897. doi: 10.2337/dc21-1944

21. Korol S, Mottet F, Perreault S et al. A systematic review and meta-analysis of the impact of mineralocorticoid receptor antagonists on glucose homeostasis. Medicine (Baltimore) 2017;96(48). doi: 10.1097/MD.0000000000008719

22. Ashjian E, Clarke M, Pogue K. Pharmacotherapy considerations with finerenone in the treatment of chronic kidney disease associated with type 2 diabetes. Am J Health Sys Pharm 2023;80(23):1708–1721. doi:10.1093/ajhp/zxad192

23. Khalimov IS, Polyakova EA, Shutova YA. A new era of cardiac nephroprotection in patients with type 2 diabetes mellitus: the role of Finerenone. Diabetes Mellitus 2024;27(6):620–628. (In Russ.) doi: 10.14341/DM13222

24. Agarwal R, Filippatos G, Pitt B et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J 2022;43(6):474–484. doi: 10.1093/eurheartj/ehab777

25. Bakris GL, Agarwal R, Anker CD et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes New Engl J Med 2020;383(23):2219–2229. doi: 10.1056/NEJMoa2025845

26. González-Juanatey JR, Górriz JL, Ortiz A et al. Cardiorenal benefits of finerenone: protecting kidney and heart. Ann Med 2023;55(1):502–513. doi: 10.1080/07853890.2023.2171110

27. Pitt B, Filippatos G, Agarwal R et al. FIGARO-DKD Investigators. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021;385(24):2252–2263. doi: 10.1056/NEJMoa2110956