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CC BY 4.0 · Journal of Diabetes and Endocrine Practice 2025; 08(01): 026-031
DOI: 10.1055/s-0044-1801821
Original Article

The Safety of Finerenone in Patients with Chronic Kidney Disease during Ramadan Fasting

Bachar Afandi
1   Endocrine Division, Tawam Hospital, Al Ain, United Arab Emirates
2   Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates
,
Fatima Alkindi
3   Department of Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
,
Yousef Boobes
4   Division of Nephrology, Seha Kidney Care, Tawam Hospital, Al Ain, United Arab Emirates
,
Latifa Baynouna Alketbi
5   Academic Affairs Department, Ambulatory Healthcare Services, Abu Dhabi Healthcare Services, Al Ain, United Arab Emirates
,
Nico Nagelkerke
6   Department of Medicine, College of Medicine and Health Sciences, Al Ain, United Arab Emirates
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Introduction Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, is used in the management of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus and albuminuria. However, the safety of finerenone during Ramadan fasting has not been evaluated previously. This study aims to evaluate the clinical outcomes of finerenone use during Ramadan fasting in this patients group.

Patients and Methods This retrospective cohort study was conducted at Tawam Hospital and Ambulatory Healthcare Services, United Arab Emirates, from July 2023 to July 2024. The study included patients on finerenone therapy and compared them to a control group of patients not using finerenone. Patients were further subdivided into Ramadan fasting and nonfasting groups. Baseline, during Ramadan, and post-Ramadan clinical and laboratory data were analyzed, including glycemic control (hemoglobin A1c [HbA1c]) and renal function (estimated glomerular filtration rate [eGFR]). To assess clinical outcomes and adverse events, descriptive and regression analyses were performed.

Results A total of 42 finerenone-treated patients were compared with 271 controls. Patients in the finerenone group had higher rates of CKD and proteinuria and were on multiple antidiabetic medications. Among patients who observed Ramadan fasting, a decline in eGFR and a decrease in HbA1c were observed in the finerenone group compared with controls. Hypoglycemia was significantly higher in the finerenone group (36.7%) than in the non-finerenone group (13%). Finerenone use and the CKD stage were significant predictors of adverse events.

Conclusion Our study highlights the potential risks associated with finerenone use during Ramadan fasting, including hypoglycemia and renal function decline. These findings emphasize the need for careful patient selection, individualized treatment adjustments, and close monitoring. Larger, prospective studies are needed to validate these observations and provide definitive guidance.

Keywords

finerenone - chronic kidney disease - diabetic kidney disease - T2 diabetes - Ramadan fasting - acute kidney injury - hypoglycemia

Authors' Contributions

All authors contributed toward conception, data collection, writing, and final approval of the manuscript.


Compliance with Ethical Principles

Ethical approval was obtained from the institutional review board of Tawam Hospital.




Publication History

Article published online:
01 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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