Finerenone versus spironolactone in patients with chronic kidney disease and type 2 diabetes: a target trial emulation

Chung-An Wang, Hsuan-Wen Lai, Jui-Yi Chen, Wei-Jie Wang, Li-Chun Lin, Yen-Ling Chiu, Chung-Yi Cheng and Vin-Cent Wu ()
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Chung-An Wang: Far Eastern Memorial Hospital
Hsuan-Wen Lai: Taipei Medical University
Jui-Yi Chen: Chi-Mei Medical Center
Wei-Jie Wang: Ministry of Health and Welfare
Li-Chun Lin: National Taiwan University Hospital
Yen-Ling Chiu: Yuan Ze University
Chung-Yi Cheng: Taipei Medical University
Vin-Cent Wu: National Taiwan University Hospital

Nature Communications, 2025, vol. 16, issue 1, 1-10

Abstract: Abstract The comparative effectiveness of finerenone and spironolactone in chronic kidney disease (CKD) with type 2 diabetes (T2D) remains unclear. Here we show, using a target trial emulation on global real-world data from TriNetX, outcomes among 2268 propensity score–matched adults with CKD (eGFR 15–60 mL/min/1.73 m²) and T2D who initiated finerenone or spironolactone between July 2021 and September 2024. Over a median follow-up of 1.3 years, finerenone is associated with lower risks of major adverse cardiovascular events (adjust hazard ratio [aHR], 0.74; 95% CI, 0.58–0.94), major adverse kidney events (aHR, 0.47; 95% CI, 0.33–0.67), all-cause mortality (aHR, 0.31; 95% CI, 0.21–0.45), and hyperkalemia (17.2% vs. 26.4%; P

Date: 2025
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DOI: 10.1038/s41467-025-64640-3

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