Background: Randomized trials have established the benefits of finerenone in type 2 diabetes with CKD; however, real-world evidence with high SGLT2 inhibitor uptake remains limited. Methods: FINE-TURK was a multicenter retrospective cohort study conducted at 56 nephrology centers in Turkey. Adults with type 2 diabetes and CKD initiating finerenone (January 2025 to June 2025) were assessed at baseline, month 1, and month 3. Primary endpoints were changes in estimated glomerular filtration rate (eGFR), serum potassium, and urinary albumin-to-creatinine ratio (UACR); hyperkalemia was defined as potassium >5.5 mEq/L. Results: Among 1,091 patients (60.6±11.5 years, 55% male), 87% received an SGLT2 inhibitor and 100% renin-angiotensin system blockade. Finerenone started at 10 mg in 85%. Paired analyses included 576 for eGFR, 648 for potassium, and 487 for UACR. Mean eGFR fell from 58.51±24.20 to 55.78±23.19 mL/min/1.73 m2 at month 1 and remained 55.78±23.13 at month 3 (both P<0.001 vs baseline). Mean potassium increased from 4.49±0.39 to 4.75±0.47 and 4.78±0.44 mEq/L (P<0.001). Median UACR declined from 690.6 (271.4-1538.0) mg/g to 468.0 (173.5-1195.5) at month 1 and 450.0 (154.5-1041.0) mg/g at month 3, corresponding to 32.2% and 34.8% reductions (P<0.001). Hyperkalemia occurred in 5.0% at both visits, commonly managed with potassium binders; hospitalizations were infrequent (2.8% and 3.1%), and no deaths occurred. Conclusions: In routine care with high SGLT2 inhibitor uptake, finerenone achieved a rapid reduction in albuminuria, with a modest early decline in eGFR, manageable potassium elevations, and low short-term event rates, supporting early use alongside standard therapy in contemporary clinical practice.

Gastrointestinal System Endoscopy and Pathological Findings in Non-Dialysis Chronic Kidney Disease: A Single-Center Study - Article abstract #946516

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 lacking. 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 (PO) was hyperkalemia risk signal (potassium ≥ 5.0 mEq/L), and the secondary outcome (SO) was clinically meaningful hyperkalemia (potassium ≥ 5.5 mEq/L). Multivariate logistic regression (LR) was used to define features associated with both PO and SO. LR, random forest (RF), gradient boosting, and CatBoost classifiers were used to define important features associated with the PO. Results: 699 patients were included. 259 (37.1%) reached the PO, and 51 (7.3%) reached the SO. Baseline potassium and estimated glomerular filtration rate (eGFR) were the most important variables associated with both outcomes and were consistently identified as the top features across all models. Thiazide use, presence of diabetic retinopathy, and diabetes duration were also associated with the PO. 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.

Bupropion is a drug used to smoke cessation. Various complications have been reported after using this drug. In a 58-year-old female patient, skin findings and anti-Ro52 positivity developed after the use of this drug. Later, signs of vasculitis appeared under immunosuppressive therapy. The patient was diagnosed with cutaneous and systemic lupus erythematosus.

Objectives: The aortic stiffness index beta (ASI-β), calculated noninvasively with the pressure change caused by arterial strain and volume changes on echocardiography, shows a strong correlation with invasive measurements of arterial stiffness. This study aimed to compare arterial stiffness and distensibility between peritoneal dialysis (PD) and hemodialysis (HD) and patients in renal replacement therapy. Methods: This cross-sectional and observational study analyzed 108 patients under renal replacement therapy (PD and HD). The aortic stiffness index beta (ASI-β) was calculated for each group. Results: The mean age of the patients in the study was 58.2±11.1 years, and 49 (45.4%) of the patients were female and 59 (54.6%) were male. Age, gender, comorbid rates, and levels of blood pressure and heart rate did not differ between the PD and HD groups. Blood pressure levels and heart rate. Mean aortic strain (5.6±1.9 vs. 9.4±2.8, p < 0.001) and median distensibility (1.5 vs. 2.9 cm, p < 0.001) were lower in the PD group than the HD group, while median ASI-β (11.6 vs. 6.2, p < 0.001) and mean E/e’ (10.6±2.9 vs. 9.2±2.3, p = 0.006) were higher in the PD group. The rate of concentric hypertrophy was higher in the PD group (47.5% vs. 23.5%, p = 0.005). Conclusion: PD patients have higher arterial stiffness and lower distensibility levels compared to HD patients. Therefore, patients with PD may be more prone to diastolic dysfunction, cardiovascular disease, and events.