Real-world utilization and clinical impact of finerenone in chronic kidney disease with cardiovascular disease: A 1-year multicentre audit across 12 units of Kauvery hospitals

Abstract

Background: Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, has emerged as an effective therapy for patients with chronic kidney disease (CKD) and coexisting cardiovascular disease (CVD). This 1-year retrospective multicentre audit evaluated real-world utilization across 12 units of Kauvery Hospitals. A total of 169 patients received 2,810 doses, predominantly 10 mg (93%). The majority of patients had coronary artery disease (41%) and combined CAD-CKD (30%), closely reflecting populations included in major clinical trials. The drug was well tolerated, with no major safety concerns observed. Despite robust clinical evidence, only 6 of 12 units actively utilized finerenone, indicating significant underuse. Additionally, advanced cardio renal therapies—including finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists—were not routinely used in heart failure management, including heart failure with preserved ejection fraction (HFpEF). Expanding the adoption of finerenone in eligible patients may significantly improve cardio renal outcomes and bridge the gap between evidence and real-world practice