Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has demonstrated significant renoprotective and cardioprotective efficacy in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) in large-scale clinical trials and real-world studies. This retrospective observational study aimed to evaluate the real-world effectiveness of low-dose finerenone (10 mg daily) in reducing urinary albumin-to-creatinine ratio (UACR) among Taiwanese patients with T2DM and CKD who were concurrently treated with both renin–angiotensin system (RAS) inhibitors and sodium–glucose cotransporter-2 (SGLT2) inhibitors. The incidence of hyperkalemia as a potential adverse event was also assessed.

This retrospective real-world study included outpatients with T2DM and CKD treated at Changhua Christian Hospital between September 2023 and February 2025. Eligible patients had documented albuminuria and received finerenone at a fixed dose of 10 mg daily, regardless of baseline estimated glomerular filtration rate (eGFR) above 60 mL/min/1.73 m². Clinical parameters, including UACR, eGFR, glycated hemoglobin (HbA1c), and serum potassium, were collected at baseline and follow-up. Changes in these parameters before and after treatment were analyzed.

A total of 120 patients with T2DM and CKD were included in the analysis. Median UACR progressively declined during follow-up, with the largest relative reduction observed in patients completing 12 months of treatment. Mean eGFR demonstrated an initial modest decline within the first 3 months, consistent with hemodynamic changes reported in the FIDELITY program, followed by stabilization thereafter. HbA1c levels remained stable throughout treatment. Serum potassium increased slightly but remained within clinically acceptable ranges, and no patient discontinued finerenone due to hyperkalemia.

Low-dose finerenone (10 mg daily) effectively reduced albuminuria and stabilized kidney function in Taiwanese patients with T2DM and CKD who were already receiving RAS inhibitors and SGLT2 inhibitors. The treatment was generally well tolerated, with only mild potassium elevations and no discontinuations related to hyperkalemia.