Personalizing kidney treatment: can biomarkers predict who benefits from finerenone?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Aged 18-75 years, male or female, with full capacity for independent conduct. * Confirmed type 2 diabetes-associated chronic kidney disease (CKD): Random urine albumin-to-creatinine ratio (UACR) of 100-5000 ug/mg Cr on two non-consecutive days; estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI formula \>25 mL/min/1.73m²; Finerenone treatment is indicated per clinical guidelines. * All concomitant medications have remained stable for 3 months prior to screening, with no planned treatment adjustments throughout the trial. Stable medication is defined as dose adjustments not exceeding ±25% of the screening baseline dose. * If the glycemic regimen includes sodium-glucose cotransporter 2 inhibitors (SGLT-2i): The daily SGLT-2i dose remains constant for 3 months before screening, and no daily dose changes are planned during the entire trial. If the glycemic regimen excludes SGLT-2i: No SGLT-2i exposure within 4 weeks prior to screening, and no SGLT-2i initiation is planned throughout the trial. * If the glycemic regimen includes glucagon-like peptide-1 receptor agonists (GLP-1RA): The daily GLP-1RA dose remains constant for 3 months before screening, and no daily dose changes are planned during the entire trial. If the glycemic regimen excludes GLP-1RA: No GLP-1RA exposure within 4 weeks prior to screening, and no GLP-1RA initiation is planned throughout the trial. * Fully understands the entire trial procedure, voluntarily participates in the study and signs the informed consent form. Exclusion Criteria: * Diagnosed or suspected type 1 diabetes, special type diabetes or secondary diabetes. * Poor glycemic control with glycated hemoglobin (HbA1c) \>9.0%. * Average seated office blood pressure measured over 3 visits with systolic blood pressure \>160 mmHg and/or diastolic blood pressure \>100 mmHg. * Serum potassium \>5.0 mmol/L without potassium supplementation. * Diagnosed or suspected chronic kidney disease unrelated to diabetic nephropathy. * Complicated with liver cirrhosis or moderate-to-severe liver impairment. * Patients with secondary aldosteronism and primary aldosteronism who have surgery plans within six months. * Confirmed Addison's disease. * Complicated with uncontrolled autoimmune diseases. * Complicated with active malignant tumors. * Presence or suspicion of depression, bipolar disorder, suicidal tendency, schizophrenia or other severe mental illnesses; or lack of mental capacity or language barrier, unable to fully understand the trial protocol or unwilling to cooperate with study site staff. * Complicated with other uncontrolled chronic diseases. * Use of serum potassium-elevating agents (e.g., amiloride, triamterene) or other mineralocorticoid receptor antagonists (MRAs, e.g., spironolactone, eplerenone) within 4 weeks prior to screening. * Use of strong CYP3A4 inhibitors (itraconazole, ketoconazole, ritonavir, nelfinavir, cobicistat, clarithromycin, telithromycin, nefazodone) or CYP3A4 inducers (carbamazepine, phenytoin, erythromycin, fluvoxamine) within 2 weeks prior to screening. * Pregnant or breastfeeding women.