Finerenone Use in Heart Failure Patients with Type 2 Diabetes and Kidney Disease: An Analysis of the FINE-TURK Registry.

backgroundFinerenone, 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.

methodsThis 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.

resultsOf 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.

conclusionsIn 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.