A Study on the Effects of Finerenone on Hemoglobin, Hematocrit, and Serum Albumin Levels in Real-World Clinical Practice.

Background Large-scale clinical studies have shown that finerenone reduces the risk of cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease (CKD). Similarly, sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce the risk of cardiovascular death and heart failure in patients with type 2 diabetes at high cardiovascular risk, with contributing factors reported to include improvements in anemia and changes in plasma volume markers, such as serum albumin (ALB) levels. The impact of finerenone on anemia and plasma volume markers has not been reported. Therefore, we hypothesized that finerenone administration might improve these factors and examined the effects of its administration on these factors. Materials and methods This retrospective observational study included 20 patients with type 2 diabetes and CKD at our hospital who initiated finerenone and had no additional medications added during the 12 months before and after administration. Changes in clinical test data, including hemoglobin (Hb), hematocrit (Ht), and serum ALB levels, were evaluated using trend-shift analysis with a mixed-effects model. Repeated measurements before and after finerenone administration were collected, and the rate of change during each period was approximated with a linear trend line. A shift in the slope of the trend line was considered an intervention effect of finerenone. Analyses were performed for all 20 participants and were stratified by concomitant SGLT2i use and baseline anemia status. Results Overall, finerenone administration significantly increased Hb and Ht levels; however, the increase was significant only in the eight patients also taking SGLT2is and not in the 12 patients who were not. Among the five patients with anemia, Hb and Ht levels increased significantly, but no significant change was observed in the three anemic patients not receiving SGLT2is. Additionally, six patients receiving SGLT2is without anemia also showed significant increases in Hb and Ht levels. These findings suggest that the combination of finerenone and SGLT2is may improve anemia. Furthermore, serum ALB levels were significantly increased with combination therapy. Conclusions Our study suggests that finerenone may improve anemia and increase ALB levels when used in combination with SGLT2is. Since the cardiovascular death and heart failure risk reduction effects of SGLT2is have already been reported, it suggests that finerenone may act additionally to the effects of SGLT2is. We believe that adding finerenone to SGLT2is could potentially provide further cardiovascular and renal risk reduction effects.