Efficacy and safety of Finerenone in patients with chronic kidney disease associated with type 2 diabetes. Latin American Experience: Findkdlatam Trial

Efficacy and safety of Finerenone in patients with chronic kidney disease associated with type 2 diabetes. Latin American Experience: Findkdlatam Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy and safety of Finerenone in patients with chronic kidney disease associated with type 2 diabetes. Latin American Experience: Findkdlatam Trial Rodrigo Daza Arnedo, Vicente Sánchez Polo, Jenniffer Benavides Garcia, and 17 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6901339/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Patients with type 2 diabetes (DM2) and chronic kidney disease (CKD) face high renal and cardiovascular risks. Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist (nsMRA), has demonstrated efficacy in reducing these risks in clinical trials. However, its real-world safety and effectiveness remain underexplored in local settings. We conducted an observational study in 347 patients with DM2 and CKD (urinary albumin-creatinine ratio [UACR] > 30 mg/g) across seven Latin American countries. Patients received Finerenone (10 or 20 mg daily), and clinical and laboratory parameters were evaluated at baseline and six months. At baseline, medians (IQR) were: HbA1c, 7.6% (6.8–8.1); eGFR, 39.0 (30.0–50.0) ml/min/1.73 m²; UACR, 345 (189–760) mg/g; SBP, 143 (130–160) mmHg; DBP, 79 (70–82) mmHg; serum potassium, 4.4 (4.1–4.7) mmol/L. After six months, significant reductions were observed: HbA1c, 7.0%; UACR, 81 mg/g; SBP, 130 mmHg; DBP, 73 mmHg. Serum potassium increased to 4.7 mmol/L (IQR 4.3–5.0), while eGFR remained stable (41.6 ml/min/1.73 m²; IQR 27.0–52.0). In our cohort of patients with chronic kidney disease associated with DM2, Finerenone proved to be an effective short-term medicine in reducing albuminuria, with very good tolerance and low risk of hyperkalemia. Finerenone Chronic kidney disease type 2 diabetes diabetic nephropathy albuminuria hyperkalemia Figures Figure 1 Figure 2 INTRODUCTION Chronic kidney disease (CKD) occurs in approximately 40% of people with type 2 diabetes mellitus (DM2). ( 1 ) This is defined by the presence of an estimated glomerular filtration rate of less than 60 ml/min/1.73m2 and/or an albuminuria/creatinuria ratio (ACR) greater than 30 mg/g, for more than 3 months. ( 2 – 4 ) Most guidelines recommend screening for CKD at least once a year in patients with DM. ( 2 ) Globally, diabetic kidney disease (DKD) is the leading cause of CKD and the leading cause of end-stage renal disease (ESRD). ( 1 ) It is estimated that in the year 2021 about 204 million people worldwide aged 20–79 years had CKD due to DM2. ( 5 – 7 ) Several interrelated factors such as hyperglycemia, dyslipidemia, chronic arterial hypertension, activation of the renin angiotensin system, and inflammation have been implicated in the development of microvascular complications in DKD. ( 8 – 11 ) The active form of the mineralocorticoid receptor (MR) is associated with systemic inflammation and CKD progression. ( 12 – 14 ) Finerenone, a selective non-steroidal MR antagonist (nsMRA) has emerged as a therapeutic option in the management of DKD. ( 15 ) Its development represents a breakthrough in the fight against renal complications associated with DM2. It has been evaluated in clinical studies such as FIDELIO-DKD and FIGARO-DKD, demonstrating significant reduction in the risk of renal disease progression and cardiovascular events in patients with DM2 and CKD with albuminuria. ( 6 , 10 ) These findings generated an important insight in its role not only in renal protection, but also as a prevention of cardiovascular complications, which is a significant benefit in patients with DM2. ( 16 – 18 ) In the present study, we analyzed the effects of Finerenone on blood pressure, glomerular filtration rate and changes in ACR in a population of patients from Latin American countries with a diagnosis of CKD associated with DM2. METHODOLOGY TYPE OF STUDY Cross-sectional descriptive observational study. Patients with a mean age of 55–71 years. The aim of this study is to evaluate the effectiveness and safety of the mineralocorticoid receptor antagonist Finerenone in seven Latin American countries. All participants were informed in writing about the nature of this study and signed the informed consent. The study was conducted in accordance with the Helsinki Declaration of Helsinki standards. POPULATION Inclusion criteria are adult patients older than 18 years, with a diagnosis of type 2 diabetes mellitus and chronic kidney disease with a urinary albumin- creatinine ratio (UACR) > 30 mg/g, relevant history of cardiovascular disease and pharmacological interventions for diabetes-associated CKD. INTERVENTION Patients received Finerenone at a daily dose of 10 or 20 mg. No comparison was made with other types of interventions, despite most patients being managed with other pharmacological groups (GLP1, ISGLT-2, ACEI, ARA II). STATISTICAL ANALYSIS Several CKD-related variables were evaluated, including HbA1c, estimated glomerular filtration rate (eGFR), ACR, systolic blood pressure (SBP), diastolic blood pressure (DBP) and serum potassium, at baseline and at six months of treatment. Qualitative variables were analyzed by calculating absolute and relative frequencies, while quantitative variables were analyzed using measures of central tendency such as median with their interquartile ranges as a measure of dispersion, given the non-parametric behavior of these variables estimated with the Kolmogorov-Smirnov test. To compare the behavior of the paraclinical parameters at baseline and at the end of treatment, the Student’s t-test was used; for comparisons of qualitative variables, the Chi-square test or Fisher’s Exact Test was used as necessary; a p-value of < 0.05 was considered statistically significant. Finally, heat maps were constructed to show the distribution of patients at baseline and at six months with respect to ACR classification and CKD classification. RESULTS A total of 347 patients from seven countries in Central and South America were included, all with type 2 diabetes mellitus, individualized management based on international guidelines and therapy for chronic kidney disease secondary to T2DM. 55.9% were male, the median age was 65 years (IQR 55–71) and the most frequent age group was under 65 years with 49.9%, followed by those between 65 and 79 years with 45.2%. Among the relevant personal history, arterial hypertension stood out in 84.7% and cardiovascular diseases in 42.7%; obesity, acute myocardial infarction and smoking were found in less than 50% of the population. Pharmacological treatment included iSGLT2 in 84.4%, RASSI 61.1% and GLP1 21%, while Finerenone was used at doses of 10 mg 55.9% and 20 mg 44.1%, Table 1 . The combination of drugs firstly showed the use of RASSI + iSGLT2 in 43.5%, followed by iSGLT2 alone in 21.6%, GLP1 + iSGLT2 in 14.1%, RASSI alone in 11.5% and in proportions lower than 10% the combinations of RASSI + GLP1 + iSGLT2, Finerenone alone, RASSI + GLP1 and GLP alone were used. (Fig. 1) Table 1 Socio-demographic characteristics and relevant background of study population N % Gender Female 153 44.1 Male 194 55.9 Med. Age (IQR) 65 (55–71) < 65 years 173 49.9 65–79 157 45.2 ≥ 80 years 17 4.9 Relevant background AHT 294 84.7 Cardiovascular disease ( a ) 148 42.7 Obesity 113 32 6 AMI 73 21.0 Smoking 56 16.1 Treatment iSGLT2 293 84.4 RASSI 212 61.1 GLP1 73 21.0 Finerenone dosage 10 194 55.9 20 153 44.1 a. Cardiovascular disease : Nonfatal acute myocardial infarction, nonfatal stroke, heart failure, peripheral arterial disease. When comparing the paraclinical parameters of HbA1c, eGFR, ACR, SBP, DBP and potassium at baseline and six months after starting Finerenone, we found medians and interquartile ranges for HbA1c 7.6 (IQR 6.8–8.1), eGFR 39.0 (30.0–50.0), ACR 345 (189–760), SBP 143 (130–160), DBP 79 (70–82) and potassium 4.4 (4.1–4.7). The final assessment showed a statistically significant decrease in HbA1c, ACR, SBP and DBP with respective medians of 7.0, 81, 130, 73, a significant increase in potassium and with Me = 4.7 (IQR 4.3-5.0), while eGFR showed no statistical difference with Median = 41.6 (IQR 27.0–52.0), Table 2 . Comparative analysis of baseline and final paraclinicals stratifying the sample by Finerenone dose showed similar behavior in all parameters at both doses except eGFR with Finerenone 10 mg where a median baseline of 33 ml/min/1.73 m2 (IQR 28–43) and baseline of 30 (IQR 26–43) were observed, p = 0.0104. (Table 2 ) Table 2 Comparison of baseline and final paraclinical parameters in total sample and stratified by Finerenone dosage Baseline Final p-value General HbA1c 7.6 (6.8–8.1) 7.0 (6.5–7.9) 0.0000 eGFR 39.0 (30.0–50.0) 41.6 (27.0–52.0) 0.7209 ACR 345 (189–760) 81 (28–167) 0.0000 SBP 143 (130–160) 130 (120–140) 0.0000 DBP 79 (70–82) 73 (70–80) 0.0000 Potassium 4.4 (4.1–4.7) 4.7 (4.3-5.0) 0.0000 Dosage 10 HbA1c 7.8 (7.0-8.1) 7.2 (6.5-8.0) 0.0002 eGFR 33 (28–43) 30 (26–43) 0.0104 ACR 430 (257–898) 90 (24–186) 0.0000 SBP 145 (135–160) 130 (120–133) 0.0000 DBP 80 (70–87) 70 (65–80) 0.0000 Potassium 4.5 (4.2–4.8) 5.0 (4.6–5.2) 0.0000 Dosage 20 HbA1c 7.3 (6.7–8.2) 6.9 (6.5–7.5) 0.0002 eGFR 46 (39–56) 49 (42–58) 0.3321 ACR 267 (153–383) 78 (34–153) 0.0000 SBP 140 (130–156) 134 (122–144) 0.0017 DBP 78 (70–80) 75 (70–80) 0.0048 Potassium 4.4 (4.0-4.6) 4.4 (4.1–4.8) 0.0098 Table 3 shows the comparative analysis of the baseline and final paraclinical parameters stratified by age group, which showed similar behavior to that of the general sample in the age groups under 65 years and between 65 and 79 years, with statistically significant decreases in HbA1c, ACR, SBP, DBP, a significant increase in potassium levels and no differences in eGFR values. However, in the age group of 80 years or older, statistical differences were only observed in ACR values with Median = 297 (IQR 85–430) in the baseline measurement and 6-month median of 27 (IQR 23–125), p = 0.0003, Table 3 . Table 4 shows the baseline behavior of the paraclinical data stratified by the six main drugs used alone or in combination. Table 3 Comparison of baseline and final paraclinical parameters stratified by age range Baseline Final p-value < 65 years HbA1c 7.8 (6.9–8.3) 7.1 (6.5–7.9) 0.0000 eGFR 42 (30–50) 44 (27–51) 0.3656 ACR 352 (189–750) 90 (29–194) 0.0000 SBP 142 (130–160) 130 (120–140) 0.0000 DBP 78 (70–84) 74 (70–80) 0.0000 Potassium 4.4 (4.0-4.6) 4.6 (4.3-5.0) 0.0000 65–79 years HbA1c 7.5 (6.7–8.1) 7.0 (6.5–7.9) 0.0027 eGFR 38 (29–49) 40 (29–55) 0.7439 ACR 327 (197–850) 86 (33–150) 0.0000 SBP 145 (134–160) 130 (120–140) 0.0000 DBP 80 (70–82) 72 (70–80) 0.0000 Potassium 4.4 (4.1–4.7) 4.8 (4.4-5.0) 0.0000 ≥ 80 years HbA1c 7.0 (6.4–7.7) 6.9 (6.4-7.0) 0.3292 eGFR 33 (30–50) 32 (27–55) 0.9365 ACR 297 (85–430) 27 (23–125) 0.0003 SBP 130 (124–150) 120 (118–130) 0.0928 DBP 77 (69–80) 70 (64–80) 0.4048 Potassium 4.5 (4.1–4.8) 4.8 (4.5–5.1) 0.0512 Table 4 Behavior of baseline paraclinical parameters stratified by drug use Baseline 1. RASSI + iSGLT2 (n = 151) HbA1c 7.5 (6.8–8.1) eGFR 44 (35–55) ACR 288 (156–454) SBP 142 (130–157) DBP 79 (70–81) Potassium 4.4 (4.1–4.6) 5. iSGLT2 alone (n = 75) HbA1c 7.8 (6.8–8.2) eGFR 32 (28–40) ACR 458 (270–900) SBP 145 (130–150) DBP 80 (70–86) Potassium 4.4 (4.1–4.6) 7. GLP1 + iSGLT2 (n = 49) HbA1c 7.7 (7.0-8.1) eGFR 32 (28–44) ACR 644 (321–950) SBP 145 (135–160) DBP 75 (70–86) Potassium 4.4 (4.0-4.7) 4. RASSI alone (n = 40) HbA1c 7.2 (6.6-8.0) eGFR 46 (34–57) ACR 266 (161–351) SBP 145 (131–160) DBP 79 (72–81) Potassium 4.4 (4.0-4.8) 3. RASSI + GLP1 + iSGLT2 (n = 18) HbA1c 7.1 (6.7-9.0) eGFR 45 (39–59) ACR 289 (173–523) SBP 144 (120–156) DBP 77 (70–86) Potassium 4.3 (4.0-4.6) 8. Finerenone alone (n = 8) HbA1c 7.5 (5.4–7.7) eGFR 30 (25–55) ACR 714 (300–1387) SBP 133 (127–170) DBP 78 (73–90) Potassium 4.8 (4.3-5.0) The clinical evolution of the patients showed the need for renal replacement therapy in 2.9% of the total sample, while 12.7% had hyperkalemia, 3.8% had to suspend treatment and 1.2% had to do so due to hyperkalemia. When comparing these events between the Finerenone dose groups used, the 10 mg group had a higher frequency of hyperkalemia and the need for treatment interruption with 19.6% and 5.7%, respectively, which were higher than those observed in the 20 mg Finerenone group, with hyperkalemia frequencies of 3.9%, p = 0.0000, and treatment interruption of 1.3%, p = 0.0335. No differences were observed in the need for renal replacement therapy or in the interruption of treatment due to hyperkalemia. (Table 5 ). Table 5 Clinical outcome of the overall sample and stratified by Finerenone dosage All N = 347 Dosage 10 N = 194 Dosage 20 N = 153 p-value Required RRT 10 (2.9) 8 (4.1) 2 (1.3) 0.1950 Hyperkalemia 44 (12.7) 38 (19.6) 6 (3.9) 0.0000 Suspended treatment 13 (3.8) 11 (5.7) 2 (1.3) 0.0335 Suspended due to hyperkalemia 4 (1.2) 4 (2.1) 0 (0.0) 0.1333 Tables 6 and 7 show the heat maps of patients’ cardiovascular risk according to eGFR and ACR levels at baseline measurement (Table 6 ) and at six months of treatment (Table 7 ). Low risk was observed in 0.3% at baseline and 4.1% at six months. High risk was 14.0% in the baseline measurement and 31.2% in the final measurement. Finally, the very high risk category had a baseline frequency of 93.3% and at six months it was 85.7%, which was statistically significant (p = 0.0004). (Fig. 2) DISCUSSION Chronic kidney disease (CKD) and cardio-metabolic conditions often coexist in the same individual, sharing common pathophysiological pathways. This cardiovascular-kidney-metabolic (CKM) overlap is increasingly recognized, and individual therapies could simultaneously ameliorate multiple related diseases. ( 19 – 22 ) Overactivation of the mineralocorticoid receptor drives inflammation and fibrosis in systemic diseases. ( 23 ) Steroid receptor antagonists, such as spironolactone and eplerenone, affect these pathways, but their use is limited, especially in patients with CKM multimorbidity. Gaps in the use of mineralocorticoid receptor antagonists in renal failure are due, in part, to safety concerns such as hyperkalemia and renal impairment. ( 24 ) Finerenone is a potent, selective non-steroidal mineralocorticoid receptor antagonist (nsMRA), with lower risks of blood potassium elevation and renal impairment compared to spironolactone. It reduces the risk of cardiovascular events and impairment of renal function in patients with DM2 and CKD with albuminuria. ( 24 ) The present study highlights the sample of 347 patients with chronic kidney disease associated with type 2 diabetes mellitus, older adults on average, relevant cardiovascular comorbidities where the significant impact of the medicine on the variables studied is evident. Efficacy was initially evaluated at six months, identifying a 76.5% decrease in ACR regardless of patient age and with no significant differences in medicine dosage. This result was twice the magnitude of the decrease in albuminuria reported in other studies. ( 10 ) In the study by Bakris et al., the average decrease was 31% at 4 months, ( 10 ) while in FIGARO-DKD, the average was 32%. ( 6 ) Other real-life studies such as that of Hanouneh et al., ( 25 ) in which a 50% decrease over 8 months in albuminuria was documented in a cohort of 402 patients with chronic kidney disease. ( 25 ) The mechanisms that could explain the positive effect of Finerenone in reducing albuminuria are not fully understood. Blocking of the overactivity of the mineralocorticoid receptor that is expressed in the podocyte, endothelial cells and mesangial cells are reported to have a relevant role. However, the fact that albuminuria decreases in the first months of treatment could imply a possible additional hemodynamic effect that could be contributing. We have proposed two possible hemodynamic mechanisms that could explain this rapid decrease in albuminuria. The first is related to the acute effect observed in the first weeks of treatment with Finerenone where an initial drop in glomerular filtration rate was observed, as evidenced in the FIDELIO-DKD and FIGARO-DKD studies, where an initial drop between 2–3 ml/minute was observed, which could attenuate the hyperfiltration state that characterizes patients with diabetic kidney disease, which could limit the amount of albumin that is filtered into the urinary space ( 23 ) . The other mechanism that could explain at least in part the early decrease of albuminuria is the effect of Finerenone on blood pressure. In the FIDELIO-DKD and FIGARO-DKD studies, only a moderate decrease of 2–3 mmHg in systolic blood pressure was observed versus placebo, and this could not fully explain the cardiorenal benefits; however, it should be considered that the blood pressure recordings in these studies were only made during medical consultation, which does not allow us to reliably infer the effect of Finerenone on blood pressure over a 24-hour period. The results are comparable with studies such as ARTS DN, a phase 2b study including patients with type 2 diabetes mellitus and chronic kidney disease, where continuous ABPM recording of blood pressure was obtained, and results showed a significant decrease of 8.3–9.9 mmHg at 90 days for doses of 10–20 mg of Finerenone, which are related to the decrease in intraglomerular pressure, which explains the filtration of proteins. ( 26 , 27 ) Despite the short half-life of Finerenone, there appears to be a sustained effect on blood pressure which does not appear to be explained by pharmacokinetic effects. Therefore, the hypothesis arises that this effect could be related to genomic effects. In our cohort, we found no difference in GFR at baseline and at the end of follow-up, which speaks for the safety of the molecule in the short term, not increasing the risk of acute renal failure or impairment of renal function. Our findings are in line with the results of Agarwal et al., ( 28 ) who reported an impairment of renal function versus placebo. In comparison to the first- and second-generation mineralocorticoid receptor antagonists, which in their studies (TOPCAT and EMPHASIS-HF) not only did not show benefits in GFR but also remained lower than that of patients assigned to placebo throughout follow-up, in addition to the fact that TOPCAT increased the risk of renal failure by 9% in patients receiving spironolactone. ( 29 , 30 ) Our results show significant decreases in SBP and DBP at six months, confirming these benefits for patients with CKD and AHT, and this would in part be a mediator of the renal efficacy seen in this study. In the analysis of different subgroups the trend on efficacy and safety results is consistent, with the exception that the group of patients receiving the 10 mg dose had more episodes of hyperkalemia and suspension of medication due to adverse effects vs. those receiving 20 mg. The reason for this is that the patients with lower doses were sicker with lower GFR at baseline, 33 vs. 46 ml/minute, which were the patients who were receiving 20 mg doses. Regarding hyperkalemia, in our cohort, the result was 12.7%, with no deaths related to hyperkalemia. The rate of treatment suspension due to episodes of hyperkalemia was also low (only 1.2%), a frequency very similar to that reported in other studies. FIGARO-DKD reported 1.2% vs. 0.4% placebo, while FIDELIO-DKD reported 2.3% vs. 0.9% placebo. We also observed a significant improvement in patients’ metabolic control at six months, which could be related to the concomitant use of diabetes medicines, such as SGLT2i (84.4%), GLP1a (21%), much more significantly than that reported in pivotal studies such as FIDELIO-DKD, where only 4.6% of patients reported using SGLT2i. The higher use of these medicines in our sample has to do with the current trend of prescribing SGLT2i, which are first-line therapy in the management of DKD. ( 2 , 31 ) Similarly, when we compared our study with FINEARTS-HF, which evaluated a sample of 6,001 patients with mildly reduced or preserved heart failure, based on their GFR results and the need to start renal replacement therapy or renal transplantation in patients using Finerenone vs. placebo, we found early and sustained decreases in albuminuria, and above all, a decrease in the occurrence of macroalbuminuria. ( 33 ) What is important about the study, compared to ours, is that it was the low-risk population that had the adverse renal outcomes. There are also ongoing studies (FINEGUST) to assess the time of drug use and its impact on temporal changes in patients with chronic kidney disease and type 2 diabetes mellitus. ( 34 ) We cannot fail to mention that in our cohort, cardiovascular risk was also modified at the end of follow-up. At baseline, patients with a very high risk account for 93.9% of the total sample. At six months that proportion decreased to 85.7% with a statistically significant p-value, a similar finding described in the study by Agarwal et al. (FIDELITY), where a higher odds of improvement in the renal risk category in the KDIGO heat map of 39% was reported, which allows us to understand that cardiovascular and renal risk is dynamic and bidirectional where a patient can migrate from a lower to a higher risk category and vice versa. ( 28 , 32 ) Our study has strengths and weaknesses. As a strength we should note that it is the first study to date of publication that has a representative sample of the region that demonstrates the efficacy and safety of Finerenone in patients with CKD and diabetes mellitus. Information was obtained from 347 patients, and to date it is one of the real-life studies with the most patients. The limitations recognized by the authors are that since this is an observational retrospective study, there is information bias, added to the fact that we cannot prove causality. The analysis by subgroup should also be taken as hypothesis-generating because the study design does not allow sufficient power for such an analysis. CONCLUSION In our cohort of patients with DM2 and chronic kidney disease in Latin America, Finerenone was shown in a short-term follow-up to be a medicine with low risk of hyperkalemia, demonstrating improvement in blood pressure, decrease in urinary albumin-creatinine ratio (UACR) and good tolerance. We consider expanding the fields of research in this intervention for the prediction of mortality and improvement of chronic kidney disease in trials with a larger sample size, studies with a lower risk of bias and comparison of interventions with a good response to the pathology described. Abbreviations DM2-Type 2 Diabetes, CKD-Chronic kidney disease, nsMRA-selective non-steroidal mineralcorticoid receptor antagonist, UACR-Urinary albumin-creatinine ratio, eGFR-Estimated glomerular filtration rate, SBP-Systolic blood pressure, DBP-Dyastolic blood pressure, ESRD-end-stage renal disease, DKD-Diabetic kidney disease, Mineralocorticoid receptor (MR), iSGLT2-sodium-glucose cotransporter type 2 inhibitors, RASSI-Renin angiotensin system inhibitors, GLP1-Glucagon-like peptide type 1, CKM- cardiovascular-kidney-metabolic, ABPM-Ambulatory Blood Pressure Monitoring, AHT-Treatment of arterial hypertension. Declarations ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Ethics Committee of the Faculty of Medical Sciences, University of San Carlos Guatemala, Graduate School. The process of acceptance of the study was led by Dr. Ever Olivie Cipriano, as representative of the ethics committee and leader of the nephrology program of said institution, accepted on January 20, 2025. The study was conducted in accordance with the Helsinki Declaration of Helsinki standards. Clinical trial number: not applicable. CONSENT FOR PUBLICATION: All authors have agreed to the publication of the data in the manuscript. AVAILABILITY OF DATA AND MATERIALS: It is hereby stated that the data sets supporting the conclusions of this study are not publicly open. All data sets supporting the conclusions of this study are available upon request from the corresponding author: Jorge Rico-Fontalvo. Nephrology Service, Nefromedical IPS. Medellín. Antioquia. Colombia. E-mail: [email protected] . ORCID https://orcid.org/0000-0002-2852-124. - Reason for restriction: Database with detailed patient information from different national and international institutions. COMPETING INTERESTS: Rodrigo Daza Arnedo states that he has received speaker’s fees for Astra Zeneca, Boehringer Ingelheim, Novo Nordisk, Bayer. He has served on Advisory Boards with AZ, Boehringer Ingelheim, Bayer and Novo Nordisk. Vicente Sánchez Polo has received speaker’s fees from Nipro, Baxter, Novartis, AstraZeneca, Bayer, Asofarma. Jenniffer Nataly Benavides Garcia works as a scientific liaison physician for Bayer SA Colombia in the cardiorenal area with a focus on diabetic kidney disease; however, her participation in this study was performed outside of work and did not conflict with her work at Bayer. Eliana Dina-Batlle has received speaker’s fees for Astra Zeneca, Novartis, Baxter, Sanofi. She has also received fees for clinical studies with Astellas and Aurinia. Eduardo Lorca-Herrera has received speaker’s fees for AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Novartis, Servier, Bayer, Merck, Axon Pharma and Lilly. He has served on Advisory Boards with Astra Zeneca. Jorge Rico Fontalvo states that he has received speaker’s fees for Astra Zeneca, Boehringer Ingelheim, Novo Nordisk, Lilly, Sanofi, Novartis, AbbVie, Merck and Bayer. He has served on Advisory Boards with AZ, Boehringer Ingelheim, Bayer and Novo Nordisk. The other authors report no conflict of interest. FUNDING: This work was carried out with the authors’ own resources. AUTHORS' CONTRIBUTIONS: All Authors made substantial contributions to the conception and design of the work; DR-TR-AA wrote main analysis, Interpretation of data. TM. the creation of new software used in the work; All authors reviewed the manuscript. ACKNOWLEDGEMENTS: We would like to thank the group of study collaborators, each of the members of this group who made this research project possible and, above all, the families of each of the authors present. References Tuttle KR, Wong L, St Peter W, Roberts G, Rangaswami J, Mottl A, et al. Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease. Clin J Am Soc Nephrol CJASN. 2022;17(7):1092–103. KDIGO. 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Vol. 105, Kidney international. United States; 2024. pp. S117–314. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2024. Diabetes Care. 2023;47(Supplement1):S219–30. Rico Fontalvo JE, Vázquez Jiménez LC, Rodríguez Yánez T, Daza Arnedo R, Raad M, Montejo Hernandez JD, et al. Enfermedad renal diabética: puesta al día. (Diabetic kidney disease: an update.) Rev An Fac Cienc Médicas . (Medical Sci Fac Journal). 2022;55(3):86–98. Duru OK, Middleton T, Tewari MK, Norris K. The Landscape of Diabetic Kidney Disease in the United States. Curr Diab Rep. 2018;18(3):14. Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021;385(24):2252–63. Filippatos G, Anker SD, Pitt B, McGuire DK, Rossing P, Ruilope LM, et al. Finerenone efficacy in patients with chronic kidney disease, type 2 diabetes and atherosclerotic cardiovascular disease. Eur Heart J Cardiovasc Pharmacother. 2022;9(1):85–93. Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021;385(19):1737–49. Baran W, Krzemińska J, Szlagor M, Wronka M, Młynarska E, Franczyk B, et al. Mineralocorticoid Receptor Antagonists-Use in Chronic Kidney Disease. Int J Mol Sci. 2021;22(18):9995. Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020;383(23):2219–29. Castillo GA, Aroca G, Buelvas J, Buitrago AF, Carballo V, Cárdenas JM, et al. Recomendaciones para el manejo del riesgo cardiorrenal en el paciente con diabetes mellitus tipo 2. (Recommendations for the management of cardiorenal risk in patients with type 2 diabetes mellitus.) Rev Colomb Cardiol . (Colombian J Cardiology). 2020;27:3–22. Chaudhuri A, Ghanim H, Arora P. Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: A review of pathophysiology, mechanisms, and evidence from recent trials. Diabetes Obes Metab. 2022;24(3):365–76. Kolkhof P, Bärfacker L. 30 YEARS OF THE MINERALOCORTICOID RECEPTOR: Mineralocorticoid receptor antagonists: 60 years of research and development. J Endocrinol. 2017;234(1):T125–40. Daza Arnedo R, Rico Fontalvo JE, Aguilar Salcedo N, Alfaro M, Navas Torrejano D, Cardona Blanco M et al. Finerenone y su papel en la enfermedad renal diabética. (Finerenone and its role in diabetic kidney disease.) Estado del arte. (State of the art.) Arch Med. (Medical archive.). 2022;18(1):5. Naaman SC, Bakris GL. Diabetic Nephropathy: Update on Pillars of Therapy Slowing Progression. Diabetes Care. 2023;46(9):1574–86. Arnedo RD, Fontalvo JER, Salcedo NA, Alfaro M, Torrejano DN, Blanco MC et al. Finerenone y su papel en la enfermedad renal diabética. (Finerenone and its role in diabetic kidney disease.) Estado del arte. (State of the art.) Arch Med. (Medical archive.). 2022;18(1):5. Rico Fontalvo J, Aroca-Martínez G, Daza-Arnedo R, Raad-Sarabia M, Torres JL, Pajaro-Galvis N et al. Enfermedad renal diabética no proteinúrica : (Non-proteinuric diabetic kidney disease:) Estado del arte. (State of the art.) Rev Nefrol Diálisis Traspl. (Transpl. Nephro. Dyalisis Journal.). 2022;42(04):330–9. Rico Fontalvo JE, Rico Fontalvo JE. Enfermedad renal diabética: de cara a la prevención, diagnóstico e intervención temprana. (Diabetic kidney disease: prevention, diagnosis and early intervention.) Rev Colomb Nefrol . (Colombian J Nephrology). 2020;7(2):15–6. Arellano AA, Castilla SM, Ortiz E, Lozano T. Perspectiva actual en manejo de Arritmias en Cardiomiopatía Chagásica. (Current perspective on arrhythmia management in Chagasic Cardiomyopathy.) Rev Cienc Bioméd. (Biomed. Sci. Journal.) 2022;11(3):211–22. Currie G, Taylor AHM, Fujita T, Ohtsu H, Lindhardt M, Rossing P, et al. Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol. 2016;17(1):127. Barrera-Chimal J, Girerd S, Jaisser F. Mineralocorticoid receptor antagonists and kidney diseases: pathophysiological basis. Kidney Int. 2019;96(2):302–19. Martinez Vargas V, Menon T, Castro M, Vijayaraghavan K. Chapter 10 - Evidence of clinical trials of cardiac outcomes on renal disease. In: Rao GHR, Das UN, editors. Cardiometabolic Diseases [Internet]. Academic Press; 2025 [cited 2024 Nov 24]. pp. 117–28. Available from: https://www.sciencedirect.com/science/article/pii/B9780323954693000280 Fujii W, Shibata S. Mineralocorticoid Receptor Antagonists for Preventing Chronic Kidney Disease Progression: Current Evidence and Future Challenges. Int J Mol Sci. 2023;24(9):7719. Singh AK, Singh A, Singh R, Misra A. Finerenone in diabetic kidney disease: A systematic review and critical appraisal. Diabetes Metab Syndr. 2022;16(10):102638. Hanouneh M, Le D, Jaar BG, Tamargo C, Cervantes CE. Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in Chronic Kidney Disease. Diagnostics. 2024;14(13):1357. Bakris GL, Agarwal R, Chan JC, Cooper ME, Gansevoort RT, Haller H, et al. Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy: A Randomized Clinical Trial. JAMA. 2015;314(9):884–94. Di Lullo L, Lavalle C, Scatena A, Mariani MV, Ronco C, Bellasi A. Finerenone: Questions and Answers-The Four Fundamental Arguments on the New-Born Promising Non-Steroidal Mineralocorticoid Receptor Antagonist. J Clin Med. 2023;12(12):3992. Agarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, 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):474–84. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383–92. Zannad F, McMurray JJV, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. N Engl J Med. 2011;364(1):11–21. Folkerts K, Millier A, Smela B, Olewinska E, Schmedt N, Mernagh P, et al. Real-world evidence for steroidal mineralocorticoid receptor antagonists in patients with chronic kidney disease. J Nephrol. 2023;36(4):1135–67. Calice-Silva V, Neyra JA, Fuentes AF, Massai KKSW, Arruebo S, Bello AK, et al. Capacity for the management of kidney failure in the International Society of Nephrology Latin America region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024;13(1):43–56. Vaduganathan M, Filippatos G, Claggett BL, Desai AS, Jhund PS, Henderson A et al. Finerenone in heart failure and chronic kidney disease with type 2 diabetes: FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes. Nat Med. 2024 Sep 1. FINEGUST. FINErenone druG Utilization Study and assessment of Temporal changes following availability of different treatment options in patients with chronic kidney disease and type 2 diabetes | CPRD [Internet]. [cited 2024 Dec 9]. Available from: https://www.cprd.com/approved-studies/finegust-finerenone-drug-utilization-study-and-assessment-temporal-changes Tables Tables 6 and 7 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table6.HeatmapforstratifyingcardiovascularriskaccordingtoGFRandACRindiabeticpatientsatbaselineassessment.docx Table7.HeatmapforstratifyingcardiovascularriskaccordingtoGFRandACRindiabeticpatientsat6monthassessment.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6901339","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":473516357,"identity":"32e3704c-3fe9-4283-97f3-e45241f2792e","order_by":0,"name":"Rodrigo Daza Arnedo","email":"","orcid":"","institution":"Asociación Colombiana de Nefrología e Hipertensión Arterial","correspondingAuthor":false,"prefix":"","firstName":"Rodrigo","middleName":"Daza","lastName":"Arnedo","suffix":""},{"id":473516358,"identity":"64a923d6-d312-47b3-aa80-41eb34f0130f","order_by":1,"name":"Vicente Sánchez Polo","email":"","orcid":"","institution":"University of San Carlos of Guatemala (USAC)","correspondingAuthor":false,"prefix":"","firstName":"Vicente","middleName":"Sánchez","lastName":"Polo","suffix":""},{"id":473516359,"identity":"5343d776-f88b-48c9-9bbf-d62f9abf19ca","order_by":2,"name":"Jenniffer Benavides Garcia","email":"","orcid":"","institution":"Rosario University, Latin American Society of Nephrology and Arterial Hypertension (SLANH)","correspondingAuthor":false,"prefix":"","firstName":"Jenniffer","middleName":"Benavides","lastName":"Garcia","suffix":""},{"id":473516360,"identity":"a9f7c350-453c-4281-997f-373b1fc9a529","order_by":3,"name":"Juan Felipe Gutiérrez","email":"","orcid":"","institution":"Davita Kidney Care","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Felipe","lastName":"Gutiérrez","suffix":""},{"id":473516361,"identity":"64cafd18-c656-4782-8cc9-2a66b8326318","order_by":4,"name":"Enrique Ramos Clason","email":"","orcid":"","institution":"Universidad del Sinú","correspondingAuthor":false,"prefix":"","firstName":"Enrique","middleName":"Ramos","lastName":"Clason","suffix":""},{"id":473516362,"identity":"fde8251b-2f62-4d22-b7b6-101502ac63ca","order_by":5,"name":"Daniel Domínguez","email":"","orcid":"","institution":"Del Valle Hospital, Catholic University of Honduras","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Domínguez","suffix":""},{"id":473516363,"identity":"121ca0ef-965f-4508-83ea-9ba6a97131fb","order_by":6,"name":"Giovanny Mera Rebutti","email":"","orcid":"","institution":"Dr. Abel Gilbert Pontón Hospital of Guayaquil, Ministry of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Giovanny","middleName":"Mera","lastName":"Rebutti","suffix":""},{"id":473516367,"identity":"44ddc0a7-c1c6-408f-8aa5-c892bc3727dd","order_by":7,"name":"Carlos Madrid Mancia","email":"","orcid":"","institution":"Transplant Committee of the Del Valle Hospital","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Madrid","lastName":"Mancia","suffix":""},{"id":473516371,"identity":"b4d040a4-3fe9-415a-a71f-f5124deb2fb7","order_by":8,"name":"Rene Tabora López","email":"","orcid":"","institution":"Del Valle Hospital, Catholic University of Honduras","correspondingAuthor":false,"prefix":"","firstName":"Rene","middleName":"Tabora","lastName":"López","suffix":""},{"id":473516373,"identity":"f3bd5c67-a6e6-41ab-b69c-ae4a406180c8","order_by":9,"name":"Manuel Rocha Meza","email":"","orcid":"","institution":"National Autonomous University of Honduras","correspondingAuthor":false,"prefix":"","firstName":"Manuel","middleName":"Rocha","lastName":"Meza","suffix":""},{"id":473516375,"identity":"3bf5cb9a-d2f6-41e0-b91d-b2a23b84933f","order_by":10,"name":"Dany Tabora López","email":"","orcid":"","institution":"Del Valle Hospital, Catholic University of Honduras","correspondingAuthor":false,"prefix":"","firstName":"Dany","middleName":"Tabora","lastName":"López","suffix":""},{"id":473516376,"identity":"5725041a-8afe-4dc4-9cf7-ca1477d354cb","order_by":11,"name":"James J. Muñoz Zambrano","email":"","orcid":"","institution":"Rafael Rodríguez Zambrano Hospital","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"J. Muñoz","lastName":"Zambrano","suffix":""},{"id":473516377,"identity":"e49ead28-9328-436a-a8e1-8e72501e10c7","order_by":12,"name":"Eduardo Lorca Herrera","email":"","orcid":"","institution":"University of Chile","correspondingAuthor":false,"prefix":"","firstName":"Eduardo","middleName":"Lorca","lastName":"Herrera","suffix":""},{"id":473516378,"identity":"77f20523-25a5-4d7d-83ef-9395d839b6d0","order_by":13,"name":"Eliana Dina-Batlle","email":"","orcid":"","institution":"Metropolitan Hospital of Santiago","correspondingAuthor":false,"prefix":"","firstName":"Eliana","middleName":"","lastName":"Dina-Batlle","suffix":""},{"id":473516379,"identity":"50e04152-733e-4d20-abd9-f533f1d26902","order_by":14,"name":"Michael Cieza Terrones","email":"","orcid":"","institution":"Peruana Cayetano Heredia University","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"Cieza","lastName":"Terrones","suffix":""},{"id":473516380,"identity":"a1a98486-80a1-4492-9877-50234c4f36d5","order_by":15,"name":"Thyago Proença Moraes","email":"","orcid":"","institution":"Pontifical Catholic University of Paraná","correspondingAuthor":false,"prefix":"","firstName":"Thyago","middleName":"Proença","lastName":"Moraes","suffix":""},{"id":473516381,"identity":"4e73b5cd-951c-4596-aed8-85b87fef09b6","order_by":16,"name":"Tomas Rodríguez Yánez","email":"","orcid":"","institution":"University of Cartagena","correspondingAuthor":false,"prefix":"","firstName":"Tomas","middleName":"Rodríguez","lastName":"Yánez","suffix":""},{"id":473516382,"identity":"55001294-7968-4ccd-b224-8efb95011819","order_by":17,"name":"Washington Osorio","email":"","orcid":"","institution":"Armed Forces Specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Washington","middleName":"","lastName":"Osorio","suffix":""},{"id":473516383,"identity":"98c46e18-ce8a-486d-818f-02d0c8c14dae","order_by":18,"name":"Alyi Arellano Cabeza","email":"","orcid":"","institution":"Hospital Universitario del Valle “Evaristo Garcia”, Universidad del Valle. Cali","correspondingAuthor":false,"prefix":"","firstName":"Alyi","middleName":"Arellano","lastName":"Cabeza","suffix":""},{"id":473516384,"identity":"7ba52eba-19c1-4a9c-befe-02f290cb0a34","order_by":19,"name":"Jorge Rico Fontalvo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACxgYwJcHAwHz4AIxHrBa2tATitCAAW44BcVqY23sfv/i4x0Ken43nm8TPHTZyDOyHj27A67Ce42aWM55JGM5s490m2XsmzZiBJy3tBl4tM9LYjHkOSCQY3O/dJsHbdjixQYLHjLCWPyAtx3ieSf4lUgvzYwaIFjZp4mzpOcbG2HMA5Bc2Y2vZtjRjNkJ+MWxvY/7w40AdMMSYH95822Yjx89++Bh+LQ0MbBJQNguYwYZPOQjIA6PmA5QNZ4yCUTAKRsEoQAEArIFH9AS8fkcAAAAASUVORK5CYII=","orcid":"","institution":"Simón Bolívar University of Barranquilla","correspondingAuthor":true,"prefix":"","firstName":"Jorge","middleName":"Rico","lastName":"Fontalvo","suffix":""}],"badges":[],"createdAt":"2025-06-16 03:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6901339/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6901339/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85368793,"identity":"89121aad-1e5c-4891-866b-ee151a2cf7fb","added_by":"auto","created_at":"2025-06-25 07:11:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26458,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6901339/v1/8a560557e34541c861ef5f02.png"},{"id":85368796,"identity":"72d6f0aa-a9b3-4959-8771-d4e75fecbdcd","added_by":"auto","created_at":"2025-06-25 07:11:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17335,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6901339/v1/fb2dc58afd169dea88b9e9d6.png"},{"id":88253205,"identity":"df3b80b9-668a-4045-ada9-b03a91098b70","added_by":"auto","created_at":"2025-08-04 13:53:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":902447,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6901339/v1/16731bd6-5c8a-4708-8406-0f5e6fdf9670.pdf"},{"id":85368795,"identity":"b5e3464d-43aa-4328-9722-af868c2bd777","added_by":"auto","created_at":"2025-06-25 07:11:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16715,"visible":true,"origin":"","legend":"","description":"","filename":"Table6.HeatmapforstratifyingcardiovascularriskaccordingtoGFRandACRindiabeticpatientsatbaselineassessment.docx","url":"https://assets-eu.researchsquare.com/files/rs-6901339/v1/2a40f09ade6256144654d76c.docx"},{"id":85369380,"identity":"0b1e2dba-34f9-4754-b095-f146a80ad226","added_by":"auto","created_at":"2025-06-25 07:19:47","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16541,"visible":true,"origin":"","legend":"","description":"","filename":"Table7.HeatmapforstratifyingcardiovascularriskaccordingtoGFRandACRindiabeticpatientsat6monthassessment.docx","url":"https://assets-eu.researchsquare.com/files/rs-6901339/v1/3279de37e8b610c583e7a912.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEfficacy and safety of Finerenone in patients with chronic kidney disease associated with type 2 diabetes. Latin American Experience: Findkdlatam Trial\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eChronic kidney disease (CKD) occurs in approximately 40% of people with type 2 diabetes mellitus (DM2). \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e This is defined by the presence of an estimated glomerular filtration rate of less than 60 ml/min/1.73m2 and/or an albuminuria/creatinuria ratio (ACR) greater than 30 mg/g, for more than 3 months. \u003csup\u003e(\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e Most guidelines recommend screening for CKD at least once a year in patients with DM. \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eGlobally, diabetic kidney disease (DKD) is the leading cause of CKD and the leading cause of end-stage renal disease (ESRD).\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e It is estimated that in the year 2021 about 204\u0026nbsp;million people worldwide aged 20\u0026ndash;79 years had CKD due to DM2.\u003csup\u003e(\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral interrelated factors such as hyperglycemia, dyslipidemia, chronic arterial hypertension, activation of the renin angiotensin system, and inflammation have been implicated in the development of microvascular complications in DKD. \u003csup\u003e(\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e The active form of the mineralocorticoid receptor (MR) is associated with systemic inflammation and CKD progression. \u003csup\u003e(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e Finerenone, a selective non-steroidal MR antagonist (nsMRA) has emerged as a therapeutic option in the management of DKD.\u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e Its development represents a breakthrough in the fight against renal complications associated with DM2. It has been evaluated in clinical studies such as FIDELIO-DKD and FIGARO-DKD, demonstrating significant reduction in the risk of renal disease progression and cardiovascular events in patients with DM2 and CKD with albuminuria. \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e These findings generated an important insight in its role not only in renal protection, but also as a prevention of cardiovascular complications, which is a significant benefit in patients with DM2. \u003csup\u003e(\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the present study, we analyzed the effects of Finerenone on blood pressure, glomerular filtration rate and changes in ACR in a population of patients from Latin American countries with a diagnosis of CKD associated with DM2.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTYPE OF STUDY\u003c/h2\u003e \u003cp\u003eCross-sectional descriptive observational study. Patients with a mean age of 55\u0026ndash;71 years. The aim of this study is to evaluate the effectiveness and safety of the mineralocorticoid receptor antagonist Finerenone in seven Latin American countries. All participants were informed in writing about the nature of this study and signed the informed consent. The study was conducted in accordance with the Helsinki Declaration of Helsinki standards.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePOPULATION\u003c/h3\u003e\n\u003cp\u003eInclusion criteria are adult patients older than 18 years, with a diagnosis of type 2 diabetes mellitus and chronic kidney disease with a urinary albumin- creatinine ratio (UACR)\u0026thinsp;\u0026gt;\u0026thinsp;30 mg/g, relevant history of cardiovascular disease and pharmacological interventions for diabetes-associated CKD.\u003c/p\u003e\n\u003ch3\u003eINTERVENTION\u003c/h3\u003e\n\u003cp\u003ePatients received Finerenone at a daily dose of 10 or 20 mg. No comparison was made with other types of interventions, despite most patients being managed with other pharmacological groups (GLP1, ISGLT-2, ACEI, ARA II).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS\u003c/h2\u003e \u003cp\u003eSeveral CKD-related variables were evaluated, including HbA1c, estimated glomerular filtration rate (eGFR), ACR, systolic blood pressure (SBP), diastolic blood pressure (DBP) and serum potassium, at baseline and at six months of treatment. Qualitative variables were analyzed by calculating absolute and relative frequencies, while quantitative variables were analyzed using measures of central tendency such as median with their interquartile ranges as a measure of dispersion, given the non-parametric behavior of these variables estimated with the Kolmogorov-Smirnov test. To compare the behavior of the paraclinical parameters at baseline and at the end of treatment, the Student\u0026rsquo;s t-test was used; for comparisons of qualitative variables, the Chi-square test or Fisher\u0026rsquo;s Exact Test was used as necessary; a p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. Finally, heat maps were constructed to show the distribution of patients at baseline and at six months with respect to ACR classification and CKD classification.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e A total of 347 patients from seven countries in Central and South America were included, all with type 2 diabetes mellitus, individualized management based on international guidelines and therapy for chronic kidney disease secondary to T2DM. 55.9% were male, the median age was 65 years (IQR 55\u0026ndash;71) and the most frequent age group was under 65 years with 49.9%, followed by those between 65 and 79 years with 45.2%. Among the relevant personal history, arterial hypertension stood out in 84.7% and cardiovascular diseases in 42.7%; obesity, acute myocardial infarction and smoking were found in less than 50% of the population. Pharmacological treatment included iSGLT2 in 84.4%, RASSI 61.1% and GLP1 21%, while Finerenone was used at doses of 10 mg 55.9% and 20 mg 44.1%, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The combination of drugs firstly showed the use of RASSI\u0026thinsp;+\u0026thinsp;iSGLT2 in 43.5%, followed by iSGLT2 alone in 21.6%, GLP1\u0026thinsp;+\u0026thinsp;iSGLT2 in 14.1%, RASSI alone in 11.5% and in proportions lower than 10% the combinations of RASSI\u0026thinsp;+\u0026thinsp;GLP1\u0026thinsp;+\u0026thinsp;iSGLT2, Finerenone alone, RASSI\u0026thinsp;+\u0026thinsp;GLP1 and GLP alone were used. (Fig.\u0026nbsp;1)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics and relevant background of study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMed. Age (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (55\u0026ndash;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelevant background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAHT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular disease (\u003csup\u003ea\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eiSGLT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRASSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGLP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinerenone dosage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003ea. Cardiovascular disease : Nonfatal acute myocardial infarction, nonfatal stroke, heart failure, peripheral arterial disease.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen comparing the paraclinical parameters of HbA1c, eGFR, ACR, SBP, DBP and potassium at baseline and six months after starting Finerenone, we found medians and interquartile ranges for HbA1c 7.6 (IQR 6.8\u0026ndash;8.1), eGFR 39.0 (30.0\u0026ndash;50.0), ACR 345 (189\u0026ndash;760), SBP 143 (130\u0026ndash;160), DBP 79 (70\u0026ndash;82) and potassium 4.4 (4.1\u0026ndash;4.7). The final assessment showed a statistically significant decrease in HbA1c, ACR, SBP and DBP with respective medians of 7.0, 81, 130, 73, a significant increase in potassium and with Me\u0026thinsp;=\u0026thinsp;4.7 (IQR 4.3-5.0), while eGFR showed no statistical difference with Median\u0026thinsp;=\u0026thinsp;41.6 (IQR 27.0\u0026ndash;52.0), Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Comparative analysis of baseline and final paraclinicals stratifying the sample by Finerenone dose showed similar behavior in all parameters at both doses except eGFR with Finerenone 10 mg where a median baseline of 33 ml/min/1.73 m2 (IQR 28\u0026ndash;43) and baseline of 30 (IQR 26\u0026ndash;43) were observed, p\u0026thinsp;=\u0026thinsp;0.0104. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline and final paraclinical parameters in total sample and stratified by Finerenone dosage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.6 (6.8\u0026ndash;8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0 (6.5\u0026ndash;7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.0 (30.0\u0026ndash;50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.6 (27.0\u0026ndash;52.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e345 (189\u0026ndash;760)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (28\u0026ndash;167)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143 (130\u0026ndash;160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (120\u0026ndash;140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (70\u0026ndash;82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (70\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.1\u0026ndash;4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7 (4.3-5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDosage 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.8 (7.0-8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.2 (6.5-8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (28\u0026ndash;43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (26\u0026ndash;43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e430 (257\u0026ndash;898)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (24\u0026ndash;186)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (135\u0026ndash;160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (120\u0026ndash;133)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (70\u0026ndash;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (65\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5 (4.2\u0026ndash;4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0 (4.6\u0026ndash;5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDosage 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.3 (6.7\u0026ndash;8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.9 (6.5\u0026ndash;7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (39\u0026ndash;56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (42\u0026ndash;58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e267 (153\u0026ndash;383)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (34\u0026ndash;153)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (130\u0026ndash;156)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134 (122\u0026ndash;144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (70\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (70\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.0-4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4 (4.1\u0026ndash;4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the comparative analysis of the baseline and final paraclinical parameters stratified by age group, which showed similar behavior to that of the general sample in the age groups under 65 years and between 65 and 79 years, with statistically significant decreases in HbA1c, ACR, SBP, DBP, a significant increase in potassium levels and no differences in eGFR values. However, in the age group of 80 years or older, statistical differences were only observed in ACR values with Median\u0026thinsp;=\u0026thinsp;297 (IQR 85\u0026ndash;430) in the baseline measurement and 6-month median of 27 (IQR 23\u0026ndash;125), p\u0026thinsp;=\u0026thinsp;0.0003, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the baseline behavior of the paraclinical data stratified by the six main drugs used alone or in combination.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline and final paraclinical parameters stratified by age range\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.8 (6.9\u0026ndash;8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1 (6.5\u0026ndash;7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (30\u0026ndash;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (27\u0026ndash;51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e352 (189\u0026ndash;750)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (29\u0026ndash;194)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142 (130\u0026ndash;160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (120\u0026ndash;140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (70\u0026ndash;84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (70\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.0-4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.6 (4.3-5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;79 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5 (6.7\u0026ndash;8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0 (6.5\u0026ndash;7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (29\u0026ndash;49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (29\u0026ndash;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e327 (197\u0026ndash;850)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (33\u0026ndash;150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (134\u0026ndash;160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (120\u0026ndash;140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (70\u0026ndash;82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (70\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.1\u0026ndash;4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8 (4.4-5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0 (6.4\u0026ndash;7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.9 (6.4-7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3292\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (30\u0026ndash;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (27\u0026ndash;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e297 (85\u0026ndash;430)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (23\u0026ndash;125)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (124\u0026ndash;150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (118\u0026ndash;130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (69\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (64\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5 (4.1\u0026ndash;4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8 (4.5\u0026ndash;5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBehavior of baseline paraclinical parameters stratified by drug use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. RASSI\u0026thinsp;+\u0026thinsp;iSGLT2 (n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5 (6.8\u0026ndash;8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (35\u0026ndash;55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e288 (156\u0026ndash;454)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142 (130\u0026ndash;157)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (70\u0026ndash;81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.1\u0026ndash;4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. iSGLT2 alone (n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.8 (6.8\u0026ndash;8.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (28\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e458 (270\u0026ndash;900)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (130\u0026ndash;150)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (70\u0026ndash;86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.1\u0026ndash;4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. GLP1\u0026thinsp;+\u0026thinsp;iSGLT2 (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.7 (7.0-8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (28\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e644 (321\u0026ndash;950)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (135\u0026ndash;160)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (70\u0026ndash;86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.0-4.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. RASSI alone (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.2 (6.6-8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (34\u0026ndash;57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e266 (161\u0026ndash;351)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (131\u0026ndash;160)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (72\u0026ndash;81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (4.0-4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. RASSI\u0026thinsp;+\u0026thinsp;GLP1\u0026thinsp;+\u0026thinsp;iSGLT2 (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1 (6.7-9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (39\u0026ndash;59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e289 (173\u0026ndash;523)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (120\u0026ndash;156)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (70\u0026ndash;86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3 (4.0-4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Finerenone alone (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5 (5.4\u0026ndash;7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (25\u0026ndash;55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e714 (300\u0026ndash;1387)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (127\u0026ndash;170)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (73\u0026ndash;90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.8 (4.3-5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe clinical evolution of the patients showed the need for renal replacement therapy in 2.9% of the total sample, while 12.7% had hyperkalemia, 3.8% had to suspend treatment and 1.2% had to do so due to hyperkalemia. When comparing these events between the Finerenone dose groups used, the 10 mg group had a higher frequency of hyperkalemia and the need for treatment interruption with 19.6% and 5.7%, respectively, which were higher than those observed in the 20 mg Finerenone group, with hyperkalemia frequencies of 3.9%, p\u0026thinsp;=\u0026thinsp;0.0000, and treatment interruption of 1.3%, p\u0026thinsp;=\u0026thinsp;0.0335. No differences were observed in the need for renal replacement therapy or in the interruption of treatment due to hyperkalemia. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical outcome of the overall sample and stratified by Finerenone dosage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;347\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDosage 10\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;194\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDosage 20\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;153\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRequired RRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1950\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperkalemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuspended treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuspended due to hyperkalemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e show the heat maps of patients\u0026rsquo; cardiovascular risk according to eGFR and ACR levels at baseline measurement (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) and at six months of treatment (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Low risk was observed in 0.3% at baseline and 4.1% at six months. High risk was 14.0% in the baseline measurement and 31.2% in the final measurement. Finally, the very high risk category had a baseline frequency of 93.3% and at six months it was 85.7%, which was statistically significant (p\u0026thinsp;=\u0026thinsp;0.0004). (Fig.\u0026nbsp;2)\u003c/p\u003e "},{"header":"DISCUSSION","content":"\u003cp\u003eChronic kidney disease (CKD) and cardio-metabolic conditions often coexist in the same individual, sharing common pathophysiological pathways. This cardiovascular-kidney-metabolic (CKM) overlap is increasingly recognized, and individual therapies could simultaneously ameliorate multiple related diseases. \u003csup\u003e(\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e Overactivation of the mineralocorticoid receptor drives inflammation and fibrosis in systemic diseases. \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e Steroid receptor antagonists, such as spironolactone and eplerenone, affect these pathways, but their use is limited, especially in patients with CKM multimorbidity. Gaps in the use of mineralocorticoid receptor antagonists in renal failure are due, in part, to safety concerns such as hyperkalemia and renal impairment. \u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e Finerenone is a potent, selective non-steroidal mineralocorticoid receptor antagonist (nsMRA), with lower risks of blood potassium elevation and renal impairment compared to spironolactone. It reduces the risk of cardiovascular events and impairment of renal function in patients with DM2 and CKD with albuminuria. \u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study highlights the sample of 347 patients with chronic kidney disease associated with type 2 diabetes mellitus, older adults on average, relevant cardiovascular comorbidities where the significant impact of the medicine on the variables studied is evident. Efficacy was initially evaluated at six months, identifying a 76.5% decrease in ACR regardless of patient age and with no significant differences in medicine dosage.\u003c/p\u003e \u003cp\u003eThis result was twice the magnitude of the decrease in albuminuria reported in other studies. \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e In the study by Bakris et al., the average decrease was 31% at 4 months, \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e while in FIGARO-DKD, the average was 32%. \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOther real-life studies such as that of Hanouneh et al., \u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e in which a 50% decrease over 8 months in albuminuria was documented in a cohort of 402 patients with chronic kidney disease. \u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe mechanisms that could explain the positive effect of Finerenone in reducing albuminuria are not fully understood. Blocking of the overactivity of the mineralocorticoid receptor that is expressed in the podocyte, endothelial cells and mesangial cells are reported to have a relevant role. However, the fact that albuminuria decreases in the first months of treatment could imply a possible additional hemodynamic effect that could be contributing. We have proposed two possible hemodynamic mechanisms that could explain this rapid decrease in albuminuria. The first is related to the acute effect observed in the first weeks of treatment with Finerenone where an initial drop in glomerular filtration rate was observed, as evidenced in the FIDELIO-DKD and FIGARO-DKD studies, where an initial drop between 2\u0026ndash;3 ml/minute was observed, which could attenuate the hyperfiltration state that characterizes patients with diabetic kidney disease, which could limit the amount of albumin that is filtered into the urinary space\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e. The other mechanism that could explain at least in part the early decrease of albuminuria is the effect of Finerenone on blood pressure. In the FIDELIO-DKD and FIGARO-DKD studies, only a moderate decrease of 2\u0026ndash;3 mmHg in systolic blood pressure was observed versus placebo, and this could not fully explain the cardiorenal benefits; however, it should be considered that the blood pressure recordings in these studies were only made during medical consultation, which does not allow us to reliably infer the effect of Finerenone on blood pressure over a 24-hour period.\u003c/p\u003e \u003cp\u003eThe results are comparable with studies such as ARTS DN, a phase 2b study including patients with type 2 diabetes mellitus and chronic kidney disease, where continuous ABPM recording of blood pressure was obtained, and results showed a significant decrease of 8.3\u0026ndash;9.9 mmHg at 90 days for doses of 10\u0026ndash;20 mg of Finerenone, which are related to the decrease in intraglomerular pressure, which explains the filtration of proteins. \u003csup\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the short half-life of Finerenone, there appears to be a sustained effect on blood pressure which does not appear to be explained by pharmacokinetic effects. Therefore, the hypothesis arises that this effect could be related to genomic effects.\u003c/p\u003e \u003cp\u003eIn our cohort, we found no difference in GFR at baseline and at the end of follow-up, which speaks for the safety of the molecule in the short term, not increasing the risk of acute renal failure or impairment of renal function. Our findings are in line with the results of Agarwal et al., \u003csup\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/sup\u003e who reported an impairment of renal function versus placebo. In comparison to the first- and second-generation mineralocorticoid receptor antagonists, which in their studies (TOPCAT and EMPHASIS-HF) not only did not show benefits in GFR but also remained lower than that of patients assigned to placebo throughout follow-up, in addition to the fact that TOPCAT increased the risk of renal failure by 9% in patients receiving spironolactone. \u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur results show significant decreases in SBP and DBP at six months, confirming these benefits for patients with CKD and AHT, and this would in part be a mediator of the renal efficacy seen in this study.\u003c/p\u003e \u003cp\u003eIn the analysis of different subgroups the trend on efficacy and safety results is consistent, with the exception that the group of patients receiving the 10 mg dose had more episodes of hyperkalemia and suspension of medication due to adverse effects vs. those receiving 20 mg. The reason for this is that the patients with lower doses were sicker with lower GFR at baseline, 33 vs. 46 ml/minute, which were the patients who were receiving 20 mg doses.\u003c/p\u003e \u003cp\u003eRegarding hyperkalemia, in our cohort, the result was 12.7%, with no deaths related to hyperkalemia. The rate of treatment suspension due to episodes of hyperkalemia was also low (only 1.2%), a frequency very similar to that reported in other studies. FIGARO-DKD reported 1.2% vs. 0.4% placebo, while FIDELIO-DKD reported 2.3% vs. 0.9% placebo.\u003c/p\u003e \u003cp\u003eWe also observed a significant improvement in patients\u0026rsquo; metabolic control at six months, which could be related to the concomitant use of diabetes medicines, such as SGLT2i (84.4%), GLP1a (21%), much more significantly than that reported in pivotal studies such as FIDELIO-DKD, where only 4.6% of patients reported using SGLT2i. The higher use of these medicines in our sample has to do with the current trend of prescribing SGLT2i, which are first-line therapy in the management of DKD. \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSimilarly, when we compared our study with FINEARTS-HF, which evaluated a sample of 6,001 patients with mildly reduced or preserved heart failure, based on their GFR results and the need to start renal replacement therapy or renal transplantation in patients using Finerenone vs. placebo, we found early and sustained decreases in albuminuria, and above all, a decrease in the occurrence of macroalbuminuria. \u003csup\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e What is important about the study, compared to ours, is that it was the low-risk population that had the adverse renal outcomes.\u003c/p\u003e \u003cp\u003eThere are also ongoing studies (FINEGUST) to assess the time of drug use and its impact on temporal changes in patients with chronic kidney disease and type 2 diabetes mellitus. \u003csup\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe cannot fail to mention that in our cohort, cardiovascular risk was also modified at the end of follow-up. At baseline, patients with a very high risk account for 93.9% of the total sample. At six months that proportion decreased to 85.7% with a statistically significant p-value, a similar finding described in the study by Agarwal et al. (FIDELITY), where a higher odds of improvement in the renal risk category in the KDIGO heat map of 39% was reported, which allows us to understand that cardiovascular and renal risk is dynamic and bidirectional where a patient can migrate from a lower to a higher risk category and vice versa. \u003csup\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur study has strengths and weaknesses. As a strength we should note that it is the first study to date of publication that has a representative sample of the region that demonstrates the efficacy and safety of Finerenone in patients with CKD and diabetes mellitus. Information was obtained from 347 patients, and to date it is one of the real-life studies with the most patients.\u003c/p\u003e \u003cp\u003eThe limitations recognized by the authors are that since this is an observational retrospective study, there is information bias, added to the fact that we cannot prove causality. The analysis by subgroup should also be taken as hypothesis-generating because the study design does not allow sufficient power for such an analysis.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn our cohort of patients with DM2 and chronic kidney disease in Latin America, Finerenone was shown in a short-term follow-up to be a medicine with low risk of hyperkalemia, demonstrating improvement in blood pressure, decrease in urinary albumin-creatinine ratio (UACR) and good tolerance. We consider expanding the fields of research in this intervention for the prediction of mortality and improvement of chronic kidney disease in trials with a larger sample size, studies with a lower risk of bias and comparison of interventions with a good response to the pathology described.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDM2-Type 2 Diabetes, CKD-Chronic kidney disease, nsMRA-selective non-steroidal mineralcorticoid receptor antagonist, UACR-Urinary albumin-creatinine ratio, eGFR-Estimated glomerular filtration rate, SBP-Systolic blood pressure, DBP-Dyastolic blood pressure, ESRD-end-stage renal disease, DKD-Diabetic kidney disease, Mineralocorticoid receptor (MR), iSGLT2-sodium-glucose cotransporter type 2 inhibitors, RASSI-Renin angiotensin system inhibitors, GLP1-Glucagon-like peptide type 1, CKM- cardiovascular-kidney-metabolic, ABPM-Ambulatory Blood Pressure Monitoring, AHT-Treatment of arterial hypertension.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE:\u0026nbsp;\u003c/strong\u003eEthics Committee of the Faculty of Medical Sciences, University of San Carlos Guatemala, Graduate School. The process of acceptance of the study was led by Dr. Ever Olivie Cipriano, as representative of the ethics committee and leader of the nephrology program of said institution, accepted on January 20, 2025. The study was conducted in accordance with the Helsinki Declaration of Helsinki standards. Clinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION:\u0026nbsp;\u003c/strong\u003eAll authors have agreed to the publication of the data in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS:\u0026nbsp;\u003c/strong\u003eIt is hereby stated that the data sets supporting the conclusions of this study are not publicly open. All data sets supporting the conclusions of this study are available upon request from the corresponding author: Jorge Rico-Fontalvo. Nephrology Service, Nefromedical IPS. Medell\u0026iacute;n. Antioquia. Colombia. E-mail: [email protected]. ORCID https://orcid.org/0000-0002-2852-124.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Reason for restriction: Database with detailed patient information from different national and international institutions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS:\u0026nbsp;\u003c/strong\u003e\u0026nbsp; Rodrigo Daza Arnedo states that he has received speaker\u0026rsquo;s fees for Astra Zeneca, Boehringer Ingelheim, Novo Nordisk, Bayer. He has served on Advisory Boards with AZ, Boehringer Ingelheim, Bayer and Novo Nordisk. Vicente S\u0026aacute;nchez Polo has received speaker\u0026rsquo;s fees from Nipro, Baxter, Novartis, AstraZeneca, Bayer, Asofarma. Jenniffer Nataly Benavides Garcia\u003csup\u003e\u0026nbsp;\u003c/sup\u003eworks as a scientific liaison physician for Bayer SA Colombia in the cardiorenal area with a focus on diabetic kidney disease; however, her participation in this study was performed outside of work and did not conflict with her work at Bayer. Eliana Dina-Batlle has received speaker\u0026rsquo;s fees for Astra Zeneca, Novartis, Baxter, Sanofi. She has also received fees for clinical studies with Astellas and Aurinia. \u0026nbsp; Eduardo Lorca-Herrera has received speaker\u0026rsquo;s fees for AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Novartis, Servier, Bayer, Merck, Axon Pharma and Lilly. He has served on Advisory Boards with Astra Zeneca. Jorge Rico Fontalvo states that he has received speaker\u0026rsquo;s fees for Astra Zeneca, Boehringer Ingelheim, Novo Nordisk, Lilly, Sanofi, Novartis, AbbVie, Merck and Bayer. He has served on Advisory Boards with AZ, Boehringer Ingelheim, Bayer and Novo Nordisk. The other authors report no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING:\u0026nbsp;\u003c/strong\u003eThis work was carried out with the authors\u0026rsquo; own resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS\u0026apos; CONTRIBUTIONS:\u0026nbsp;\u003c/strong\u003eAll Authors made substantial contributions to the conception and design of the work; DR-TR-AA wrote main analysis, Interpretation of data. TM. the creation of new software used in the work; All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS:\u0026nbsp;\u003c/strong\u003eWe would like to thank the group of study collaborators, each of the members of this group who made this research project possible and, above all, the families of each of the authors present.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTuttle KR, Wong L, St Peter W, Roberts G, Rangaswami J, Mottl A, et al. Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease. Clin J Am Soc Nephrol CJASN. 2022;17(7):1092\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKDIGO. 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Vol. 105, Kidney international. United States; 2024. pp. S117\u0026ndash;314.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes\u0026mdash;2024. Diabetes Care. 2023;47(Supplement1):S219\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRico Fontalvo JE, V\u0026aacute;zquez Jim\u0026eacute;nez LC, Rodr\u0026iacute;guez Y\u0026aacute;nez T, Daza Arnedo R, Raad M, Montejo Hernandez JD, et al. \u003cem\u003eEnfermedad renal diab\u0026eacute;tica: puesta al d\u0026iacute;a.\u003c/em\u003e (Diabetic kidney disease: an update.) \u003cem\u003eRev An Fac Cienc M\u0026eacute;dicas\u003c/em\u003e. (Medical Sci Fac Journal). 2022;55(3):86\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuru OK, Middleton T, Tewari MK, Norris K. The Landscape of Diabetic Kidney Disease in the United States. Curr Diab Rep. 2018;18(3):14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021;385(24):2252\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFilippatos G, Anker SD, Pitt B, McGuire DK, Rossing P, Ruilope LM, et al. Finerenone efficacy in patients with chronic kidney disease, type 2 diabetes and atherosclerotic cardiovascular disease. Eur Heart J Cardiovasc Pharmacother. 2022;9(1):85\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021;385(19):1737\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaran W, Krzemińska J, Szlagor M, Wronka M, Młynarska E, Franczyk B, et al. Mineralocorticoid Receptor Antagonists-Use in Chronic Kidney Disease. Int J Mol Sci. 2021;22(18):9995.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020;383(23):2219\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastillo GA, Aroca G, Buelvas J, Buitrago AF, Carballo V, C\u0026aacute;rdenas JM, et al. \u003cem\u003eRecomendaciones para el manejo del riesgo cardiorrenal en el paciente con diabetes mellitus tipo 2.\u003c/em\u003e (Recommendations for the management of cardiorenal risk in patients with type 2 diabetes mellitus.) \u003cem\u003eRev Colomb Cardiol\u003c/em\u003e. (Colombian J Cardiology). 2020;27:3\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaudhuri A, Ghanim H, Arora P. Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: A review of pathophysiology, mechanisms, and evidence from recent trials. Diabetes Obes Metab. 2022;24(3):365\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolkhof P, B\u0026auml;rfacker L. 30 YEARS OF THE MINERALOCORTICOID RECEPTOR: Mineralocorticoid receptor antagonists: 60 years of research and development. J Endocrinol. 2017;234(1):T125\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaza Arnedo R, Rico Fontalvo JE, Aguilar Salcedo N, Alfaro M, Navas Torrejano D, Cardona Blanco M et al. \u003cem\u003eFinerenone y su papel en la enfermedad renal diab\u0026eacute;tica.\u003c/em\u003e (Finerenone and its role in diabetic kidney disease.) \u003cem\u003eEstado del arte.\u003c/em\u003e (State of the art.) \u003cem\u003eArch Med.\u003c/em\u003e (Medical archive.). 2022;18(1):5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaaman SC, Bakris GL. Diabetic Nephropathy: Update on Pillars of Therapy Slowing Progression. Diabetes Care. 2023;46(9):1574\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArnedo RD, Fontalvo JER, Salcedo NA, Alfaro M, Torrejano DN, Blanco MC et al. \u003cem\u003eFinerenone y su papel en la enfermedad renal diab\u0026eacute;tica.\u003c/em\u003e (Finerenone and its role in diabetic kidney disease.) \u003cem\u003eEstado del arte.\u003c/em\u003e (State of the art.) \u003cem\u003eArch Med.\u003c/em\u003e (Medical archive.). 2022;18(1):5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRico Fontalvo J, Aroca-Mart\u0026iacute;nez G, Daza-Arnedo R, Raad-Sarabia M, Torres JL, Pajaro-Galvis N et al. \u003cem\u003eEnfermedad renal diab\u0026eacute;tica no protein\u0026uacute;rica\u003c/em\u003e: (Non-proteinuric diabetic kidney disease:) \u003cem\u003eEstado del arte.\u003c/em\u003e (State of the art.) \u003cem\u003eRev Nefrol Di\u0026aacute;lisis Traspl.\u003c/em\u003e (Transpl. Nephro. Dyalisis Journal.). 2022;42(04):330\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRico Fontalvo JE, Rico Fontalvo JE. \u003cem\u003eEnfermedad renal diab\u0026eacute;tica: de cara a la prevenci\u0026oacute;n, diagn\u0026oacute;stico e intervenci\u0026oacute;n temprana.\u003c/em\u003e (Diabetic kidney disease: prevention, diagnosis and early intervention.) \u003cem\u003eRev Colomb Nefrol\u003c/em\u003e. (Colombian J Nephrology). 2020;7(2):15\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArellano AA, Castilla SM, Ortiz E, Lozano T. \u003cem\u003ePerspectiva actual en manejo de Arritmias en Cardiomiopat\u0026iacute;a Chag\u0026aacute;sica.\u003c/em\u003e (Current perspective on arrhythmia management in Chagasic Cardiomyopathy.) Rev Cienc Biom\u0026eacute;d. (Biomed. Sci. Journal.) 2022;11(3):211\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCurrie G, Taylor AHM, Fujita T, Ohtsu H, Lindhardt M, Rossing P, et al. Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol. 2016;17(1):127.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrera-Chimal J, Girerd S, Jaisser F. Mineralocorticoid receptor antagonists and kidney diseases: pathophysiological basis. Kidney Int. 2019;96(2):302\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartinez Vargas V, Menon T, Castro M, Vijayaraghavan K. Chapter 10 - Evidence of clinical trials of cardiac outcomes on renal disease. In: Rao GHR, Das UN, editors. Cardiometabolic Diseases [Internet]. Academic Press; 2025 [cited 2024 Nov 24]. pp. 117\u0026ndash;28. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/B9780323954693000280\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/B9780323954693000280\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujii W, Shibata S. Mineralocorticoid Receptor Antagonists for Preventing Chronic Kidney Disease Progression: Current Evidence and Future Challenges. Int J Mol Sci. 2023;24(9):7719.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh AK, Singh A, Singh R, Misra A. Finerenone in diabetic kidney disease: A systematic review and critical appraisal. Diabetes Metab Syndr. 2022;16(10):102638.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanouneh M, Le D, Jaar BG, Tamargo C, Cervantes CE. Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in Chronic Kidney Disease. Diagnostics. 2024;14(13):1357.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakris GL, Agarwal R, Chan JC, Cooper ME, Gansevoort RT, Haller H, et al. Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy: A Randomized Clinical Trial. JAMA. 2015;314(9):884\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Lullo L, Lavalle C, Scatena A, Mariani MV, Ronco C, Bellasi A. Finerenone: Questions and Answers-The Four Fundamental Arguments on the New-Born Promising Non-Steroidal Mineralocorticoid Receptor Antagonist. J Clin Med. 2023;12(12):3992.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, 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\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZannad F, McMurray JJV, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. N Engl J Med. 2011;364(1):11\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFolkerts K, Millier A, Smela B, Olewinska E, Schmedt N, Mernagh P, et al. Real-world evidence for steroidal mineralocorticoid receptor antagonists in patients with chronic kidney disease. J Nephrol. 2023;36(4):1135\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalice-Silva V, Neyra JA, Fuentes AF, Massai KKSW, Arruebo S, Bello AK, et al. Capacity for the management of kidney failure in the International Society of Nephrology Latin America region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl. 2024;13(1):43\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaduganathan M, Filippatos G, Claggett BL, Desai AS, Jhund PS, Henderson A et al. Finerenone in heart failure and chronic kidney disease with type 2 diabetes: FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes. Nat Med. 2024 Sep 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFINEGUST. FINErenone druG Utilization Study and assessment of Temporal changes following availability of different treatment options in patients with chronic kidney disease and type 2 diabetes | CPRD [Internet]. [cited 2024 Dec 9]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cprd.com/approved-studies/finegust-finerenone-drug-utilization-study-and-assessment-temporal-changes\u003c/span\u003e\u003cspan address=\"https://www.cprd.com/approved-studies/finegust-finerenone-drug-utilization-study-and-assessment-temporal-changes\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 6 and 7 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Finerenone, Chronic kidney disease, type 2 diabetes, diabetic nephropathy, albuminuria, hyperkalemia","lastPublishedDoi":"10.21203/rs.3.rs-6901339/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6901339/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePatients with type 2 diabetes (DM2) and chronic kidney disease (CKD) face high renal and cardiovascular risks. Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist (nsMRA), has demonstrated efficacy in reducing these risks in clinical trials. However, its real-world safety and effectiveness remain underexplored in local settings.\u003c/p\u003e \u003cp\u003eWe conducted an observational study in 347 patients with DM2 and CKD (urinary albumin-creatinine ratio [UACR]\u0026thinsp;\u0026gt;\u0026thinsp;30 mg/g) across seven Latin American countries. Patients received Finerenone (10 or 20 mg daily), and clinical and laboratory parameters were evaluated at baseline and six months.\u003c/p\u003e \u003cp\u003eAt baseline, medians (IQR) were: HbA1c, 7.6% (6.8\u0026ndash;8.1); eGFR, 39.0 (30.0\u0026ndash;50.0) ml/min/1.73 m\u0026sup2;; UACR, 345 (189\u0026ndash;760) mg/g; SBP, 143 (130\u0026ndash;160) mmHg; DBP, 79 (70\u0026ndash;82) mmHg; serum potassium, 4.4 (4.1\u0026ndash;4.7) mmol/L. After six months, significant reductions were observed: HbA1c, 7.0%; UACR, 81 mg/g; SBP, 130 mmHg; DBP, 73 mmHg. Serum potassium increased to 4.7 mmol/L (IQR 4.3\u0026ndash;5.0), while eGFR remained stable (41.6 ml/min/1.73 m\u0026sup2;; IQR 27.0\u0026ndash;52.0).\u003c/p\u003e \u003cp\u003eIn our cohort of patients with chronic kidney disease associated with DM2, Finerenone proved to be an effective short-term medicine in reducing albuminuria, with very good tolerance and low risk of hyperkalemia.\u003c/p\u003e","manuscriptTitle":"Efficacy and safety of Finerenone in patients with chronic kidney disease associated with type 2 diabetes. Latin American Experience: Findkdlatam Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 07:11:42","doi":"10.21203/rs.3.rs-6901339/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"947ce3e0-3b41-48eb-98de-97c00d1434bc","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T13:53:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-25 07:11:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6901339","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6901339","identity":"rs-6901339","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}