Clin Exp Nephrol. 2026 Jun 8. doi: 10.1007/s10157-026-02898-7. Online ahead of print.
ABSTRACT
BACKGROUND: Finerenone improves cardiovascular and kidney outcomes in patients with type 2 diabetes and chronic kidney disease; however, hyperkalemia remains a safety concern in routine practice. We evaluated the incidence of hyperkalemia, factors associated with its occurrence, and temporal patterns of serum potassium after finerenone initiation.
METHODS: We conducted a single-center retrospective observational cohort study of patients who initiated finerenone between May 2022 and August 2025. The primary outcome was incident hyperkalemia (serum potassium ≥ 5.5 mEq/L). Candidate variables were selected using least absolute shrinkage and selection operator (LASSO)-penalized Cox regression, and associations were estimated using multivariable Cox proportional hazards models. Potassium trajectories were assessed using mixed-effects models over 12 months (6 months before and after finerenone initiation), with subgroup analyses by kidney function and baseline potassium.
RESULTS: Among 289 eligible patients, 280 were included (mean age 68 years; 68% male; mean baseline eGFR of 36.8 mL/min/1.73 m2). Hyperkalemia occurred in 38 patients. Incident hyperkalemia was associated with higher baseline potassium and log-transformed C-reactive protein and with use of diuretics and potassium binders. Mean serum potassium increased by approximately 0.10 mEq/L over six months, with the largest rise in the first 1-2 months. Patients with eGFR < 30 mL/min/1.73 m2 or baseline potassium ≥ 4.5 mEq/L had higher potassium levels throughout follow-up.
CONCLUSIONS: Finerenone was generally well tolerated, with modest potassium increases. In our real-world cohort, hyperkalemia occurred in a notable proportion of patients, underscoring the importance of early monitoring, particularly in those with reduced kidney function or elevated baseline potassium.
PMID:42258056 | DOI:10.1007/s10157-026-02898-7