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논문분류	춘계학술대회 초록집
제목	Efficacy and Safety of Finerenone in Elderly Patients with Diabetic Kidney Disease: A Single-Center Real-World Experience in Korea
저자	Kyubok Jin
출판정보	2026; 2026(1):
키워드	finerenone, Diabetic kidney disease, proteinuria, hyperkalemia
초록	Objectives: Finerenone has demonstrated cardiorenal benefits in patients with diabetic kidney disease (DKD). The FIDELITY pooled analysis showed consistent cardiovascular benefits across age subgroups, but real-world data on finerenone use in elderly patients remain scarce, particularly in Asian populations. Methods: We retrospectively analyzed 98 DKD patients initiated finerenone at a single Korean tertiary center between February 2024 and November 2025. Patients were stratified by age: ≥65 years (n=43) and <65 years (n=55). The primary endpoint was urine protein-to-creatinine ratio (UPCR) change at 3 months, with ≥30% reduction as the categorical response criterion. Safety endpoints included hyperkalemia (serum potassium >5.5 mmol/L), eGFR change, and drug discontinuation rate with causes. Results: Baseline eGFR (51.3 vs 47.3 mL/min/1.73m2, p=0.949), serum potassium (4.6 vs 4.5 mmol/L, p=0.565), and albumin (4.3 vs 4.2 g/dL, p=0.335) were comparable. SGLT2 inhibitor co-prescription was significantly lower in the elderly group (27.9% vs 50.9%, p=0.024). Among 57 patients with paired UPCR data (≥65: n=22, <65: n=35), the elderly group showed a geometric mean UPCR reduction of 49.8% (2.50→0.75 g/g, p=0.015) versus 18.8% in younger patients (3.76→2.32 g/g, p=0.045). The ≥30% UPCR reduction rate was comparable between groups (59.1% vs 34.3%, p=0.100). The eGFR decline was also comparable between groups (−2.5±10.2 vs −2.2±9.6 mL/min/1.73m2, p=0.752). Regarding safety concerns, hyperkalemia incidence was similar between 2 groups (9.3% vs 12.7%, p=0.751). Drug discontinuation occurred in 6 elderly (14.0%) and 5 younger patients (9.1%, p=0.527), primarily due to creatinine elevation (≥65: n=3, <65: n=1), potassium elevation (≥65: n=2, <65: n=1), and combined creatinine-potassium elevation (≥65: n=1, <65: n=2). Conclusion: In this real-world Korean cohort, finerenone demonstrated significant proteinuria reduction in elderly DKD patients, with comparable response rates to younger patients. The safety profile, including hyperkalemia and discontinuation rates, was also comparable between age groups. These findings support the use of finerenone in elderly Korean patients with DKD.
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