ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Renal Pharmacology
This article is part of the Research TopicCardiorenal Metabolic Health and Diabetic Nephropathy: Mechanisms, Biomarkers, and Therapeutic AdvancesView all 8 articles
Finerenone Is Associated with Pronounced Uric Acid Reduction in Hyperuricemic Diabetic Kidney Disease: A Real-World Analysis
Provisionally accepted
- 1Department of Endocrinology, Xiang'an Hospital, Xiamen University, Xiamen, China
- 2Fujian Medical University Xiamen Hong'ai Hospital, Xiamen, China
- 3The First Affiliated Hospital of Xiamen University, Xiamen, China
- 4zoe soft company, xiamen, China
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Background: Diabetic kidney disease (DKD) is a critical complication of type 2 diabetes, often compounded by hyperuricemia, which may accelerate renal function decline. While finerenone, a nonsteroidal mineralocorticoid receptor antagonist (MRA), provides renal and cardiovascular benefits, its impact on uric acid (UA) metabolism in real-world DKD patients, particularly those with high baseline SUA, remains controversial. Methods: In this retrospective, single-center study, we included 124 patients with type 2 DKD (baseline eGFR ≥60 mL/min/1.73 m²) who initiated finerenone. Patients with recent gout or urate-lowering therapy were excluded. Changes in SUA, urinary albumin-to-creatinine ratio (UACR), and eGFR were assessed before and after 1-3 months of treatment. Statistical analyses employed linear mixed models for longitudinal data and multivariable regression. Results: Linear mixed model analysis showed finerenone treatment was associated with a significant reduction in SUA (adjusted mean difference: -47.9 µmol/L, 95% CI: -63.5 to -32.3; p < 0.001). This reduction was substantially greater in patients with baseline hyperuricemia (-88.6 µmol/L) than in those without (-16.6 µmol/L; p for interaction=0.003). UACR decreased by 39.4% (p < 0.001), while eGFR showed a small but significant decline (-2.7 mL/min/1.73 m², p=0.019). The SUA-lowering association was independent of concomitant SGLT2 inhibitor or GLP-1 receptor agonist use in multivariable analyses. Hyperkalemia (potassium ≥5.5 mmol/L) occurred in 0.8% of patients. Conclusions: In this real-world cohort, finerenone use was associated with significant reductions in albuminuria and SUA, particularly among patients with hyperuricemia. These findings suggest a potential dual benefit in this high-risk subgroup and highlight the importance of baseline SUA in interpreting finerenone's metabolic effects. The observed SUA reduction warrants further prospective investigation.
Keywords: Diabetic kidney disease, finerenone, Hyperuricemia, Mineralocorticoid receptor antagonist, Uric Acid
Received: 07 Jan 2026; Accepted: 05 Feb 2026.
Copyright: © 2026 Lin, Tian, Liu and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bo Liu
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