Hyperkalemia risk with finerenone in diabetic kidney disease: a real-world analysis from the FINE-TURK cohort

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ID: 319819
2026
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Abstract
Abstract Background Finerenone is associated with a lower, yet clinically relevant, risk of hyperkalemia compared with steroidal mineralocorticoid receptor antagonists in diabetic kidney disease (DKD) trials. However, real-world data on hyperkalemia and its associated factors are scarce. Methodology FINE-TURK is a national, observational cohort of DKD patients who were initiated on finerenone. Eligible adults were included; demographic, clinical, and laboratory data were evaluated. The primary outcome was hyperkalemia risk signal (potassium ≥ 5.0 mEq/L), and the secondary outcome was clinically meaningful hyperkalemia (potassium ≥ 5.5 mEq/L) within 3 months. Multivariate logistic regression (LR) was used to define features associated with the both outcomes. Machine learning methods of LR, random forest (RF), extreme gradient boosting, and categorical boosting classifiers were used to define important features associated with the primary outcome. Results 699 patients were included. 259 (37.1%) reached the primary outcome, and 51 (7.3%) reached the secondary outcome. Baseline serum potassium, estimated glomerular filtration rate (eGFR), and finerenone dose were associated with the both outcomes in multivariate LR. Machine learning analyses consistently identified baseline serum potassium and eGFR as the most influential factors associated with primary outcome, with thiazide use being associated with lower risk and 20 mg (compared to 10 mg) finerenone initiation being associated with higher risk. LR demonstrated the highest recall; random forest achieved the highest precision in performance. Discussion Real-world data suggest that the risk of clinically meaningful hyperkalemia is similar to that in the clinical trials. In parallel with the safety analysis of clinical trials, baseline potassium and eGFR were consistently the most important factors associated with hyperkalemia risk.
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Authors Murat Özdede, Serap Yadigar, Alper Tuna Güven, Suat Akgür, Felemez Arslan, Mehmet Sezen, Büşra Özcan, Elif Yıldırım Ayaz, Betül Doğantekin, İlker Atay, Serpil Müge Değer, Mustafa Demir, Sümeyra Koyuncu, Üstün Yılmaz, Ayça İnci, Ramazan Sarı, Funda Sarı, Hülya Çolak, Bülent Demirelli, Serhan Tuğlular, EBRU GÖK OĞUZ, Mehmet Deniz Aylı, Ezgi Avanaz, Fatih Yılmaz, Beyza Doğan, Süleyman Karaköse, Mine Şebnem Karakan, Bahar Gürlek Demirci, Kültiğin Türkmen, İsmail Baloğlu, Mehmet Batmazoğlu, Mehmet Mert, Emre Aydın, Fatma Yılmaz Aydın, Ergün Parmaksız, Pınar Özdemir, Bartu Ediz, Zeki Aydın, Mehmet Emin Demir, Siren Sezer, Suat Ünver, Öznur Baykal, Beril Akman, Atila Altuntaş, Mahmud İslam, Sibel Yücel Koçak, Meral Mert, Belda Dursun, Necmi Eren, Simge Bardak Demir, Mukadder Ayşe Bilgiç, Arda Erdut, Gülşah Keskin, Mehmet Horoz, Ahmet Ziya Şahin, Merve Tekinyıldız, Murat Duranay, Serkan Feyyaz Yalın, Hazal Melike Yavuz Umut, Murat Altunok, Di̇lek Torun, Serdar Kahvecioğlu, Asena Serap Yalcinkaya, Tülin Akagün, Hüseyin Çelik, Sinan Kazan, İlyas Öztürk, Mehmet POLAT, Mehmet Fethullah Aydın, Meral Meşe, Asil Demirezen, Ulver Derici, Eda Altun, Serkan Bakırdöğen, Ekrem Kara, Cüneyt Akgöl, Mahmut Başar Aykent, Ali İLTER, Ahmet Ekmekci, Sena Ulu, Mustafa Arıcı, Erkan Şengül, Elif Arı
Journal clinical kidney journal
Year 2026
DOI
10.1093/ckj/sfag227
URL
https://doi.org/10.1093/ckj/sfag227
Keywords Keywords not found

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