AIM: No studies have specifically examined the effects of finerenone in treating type 2 diabetes patients with chronic kidney disease (CKD) and microalbuminuria. This study aimed to evaluate the effectiveness of finerenone in this group of patients. METHODS: This retrospective real-world study (ChiCTR2400087169) included type 2 diabetes outpatients with CKD from the Peking University First Hospital between March 2023 and March 2024. All patients in this study had a urinary albumin-to-creatinine ratio (UACR) of 30-299 mg/g. The effects of finerenone were assessed by comparing UACR, HbA1c, creatinine, serum potassium, eGFR, and blood pressure at baseline and after treatment. RESULTS: Sixty-four patients (39 males and 25 females), with a median age of 65.75 years and a median duration of T2DM of 15.21 years, were included. The baseline median UACR was 100.50 mg/g, significantly decreased to 61.27 mg/g (P <
0.001) at 3 months and 62.49 mg/g (P <
0.001) at 6 months after treatment. None of the other parameters differed significantly. Finerenone alone or in combination with ABS inhibitors, SGLT2 inhibitors, or GLP-1 agonists did not result in significant differences in UACR reduction. Patients with a >
30% UACR decrease had significantly higher baseline systolic blood pressure (SBP) than those with a ≤30% decrease (P <
0.05). Furthermore, baseline SBP significantly decreased after 6 months of treatment in patients with a >
30% UACR reduction (P <
0.05). CONCLUSIONS: Finerenone is effective in treating type 2 diabetes with CKD and microalbuminuria. Improved SBP control leads to a greater UACR reduction.