Abstract
AIMS: Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are the foundation of renoprotective therapy in chronic kidney disease (CKD). However, some patients cannot tolerate these agents. This study aimed to evaluate the efficacy and safety of finerenone in patients with or without ACEi/ARB therapy. METHODS: We retrospectively analyzed 83 patients with CKD and diabetes who received finerenone for ≥ 3 months at our hospital (June 2022 to March 2025). The patients were divided into ACEi/ARB users (n = 52) and non-users (n = 31). Changes in the estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, and serum potassium concentrations were compared. RESULTS: The urinary albumin-to-creatinine ratio significantly decreased after finerenone treatment in both groups (ACEi/ARB: 478 to 143 mg/gCr, p < 0.001; non-ACEi/ARB: 548 to 433 mg/gCr, p = 0.049). The degree of this reduction was greater in the ACEi/ARB group than in the non-ACEi/ARB group (0.376 vs. 0.846, p = 0.006). The estimated glomerular filtration rate significantly declined after finerenone treatment in the ACEi/ARB group (40 to 36.5 mL/min/1.73 m(2), p = 0.004) but not in the non-ACEi/ARB group. Serum potassium concentrations slightly increased after finerenone treatment in the ACEi/ARB group (p = 0.014) but not in the non-ACEi/ARB group. Adverse events included hyperkalemia (n = 7), renal failure (n = 1), and discontinuation in 11 patients. CONCLUSIONS: Finerenone reduces albuminuria even without ACEis/ARBs, but the effect is more pronounced with co-administration, albeit with higher risks of a decline in the estimated glomerular filtration rate and hyperkalemia. Finerenone monotherapy may be beneficial when ACEis/ARBs cannot be used, whereas combined therapy remains more effective but requires careful monitoring. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13340-025-00866-2.