Aim: Finerenone is safe and efficacious for treating patients with chronic kidney disease (CKD) and Type 2 diabetes (T2D). Evidence on the use of finerenone in clinical practice is lacking. Objective: To describe demographic and clinical characteristics of early adopters of finerenone in the United States, according to sodium-glucose cotransporter 2 inhibitor (SGLT2i) use and urine albumin–creatinine ratio (UACR) levels. Methods: Multi-database, observational, cross-sectional study, using data from two US databases (Optum Claims and Optum EHR). Three cohorts were included: finerenone initiators with prior CKD-T2D, finerenone initiators with prior CKD-T2D and concomitant SGLT2i use, finerenone initiators with prior CKD-T2D stratified according to UACR. Results: In total, 1015 patients were included, 353 from Optum Claims and 662 from Optum EHR. Mean age was 72.0 and 68.4 years in Optum claims and EHR, respectively. Median eGFR was 44 and 44 ml/min/1.73 m 2 ; and median UACR was 132 (28–698)/365 (74–1185.4) mg/g, in Optum Claims and EHR, respectively. 70.5/70.4% were taking renin-angiotensin system inhibitors, 42.5/53.3% SGLT2i. Overall, 9.0/6.3% of patients had baseline UACR <30 mg/g, 15.0/20.2% had UACR 30–300 mg/g, and 14.4/27.6% had UACR >300 mg/g. Conclusion: Current management of patients with CKD-T2D reflects use of finerenone independently from background therapies and clinical characteristics, suggesting implementation of therapeutic strategies based on different modes of action.

Abstract. Georeferenced field data collection has become a popular practice allowing everyone to contribute to mapping objects or reporting events. The spread of mobile devices - capable of recording and sharing location coordinates, media and features while on the go - is primarily accountable for such diffusion. Accordingly, a number of mobile apps and software frameworks have been developed and released to perform field data collection. These frameworks allow to customize and dispatch collection forms as well as to manage contributors and records through web interfaces or database management systems. From the contributors’ perspective, specific mobile client apps need to be installed to access selectively the collection forms and contribute to the data collection on the field using their mobile devices. This operation might inhibit the sporadic contribution of occasional users who may not be willing to install additional software. To overcome this limitation, this work presents the Geo Collector Bot, an alternative software toolkit to empower field data collection projects avoiding the development and/or the installation of a specific mobile app on contributors’ devices. The Geo Collector Bot is a configurable Telegram-based chatbot enabling to dispatch of data collection forms that can be activated and filled in through Telegram chats. The ultimate goal of the presented work is to provide an alternative free and open-source software framework suitable for general-purpose field data collection applications. Development patterns and system architecture are described in detail alongside future improvements and outlooks for the Geo Collector Bot project.

Background and Aims Hyperkalemia (HK) is associated with significant risks for premature mortality, adverse clinical outcomes, and with a potentially more rapid decline of renal function. Reported numbers on the epidemiology of HK in patients diagnosed with chronic kidney disease (CKD) vary significantly and are unclear in real-world patients across different CKD stages, eGFR and UACR strata. We aimed to evaluate the occurrence of moderate to severe hyperkalemia episodes among a large, representative sample of patients with CKD from the US between 2009 and 2020. Method Using Optum Electronic Health Records data, we included patients with CKD between January 2009 and December 2020, who had at least two qualifying estimated glomerular filtration rate (eGFR) (15-60 ml/min/1.73 m2) and/or UACR values (≥30 mg/g) between 90 and 365 days apart. The second qualifying value was considered confirmatory and set as the index date. Patients had to have 365 days of baseline activity prior to index, be ≥18 years of age, and not show any diagnoses, procedures, or lab values of kidney failure or hemodialysis or kidney transplant during baseline. A HK episode was defined in two ways, (1.) as either a combination of two elevated inpatient or outpatient serum potassium values (sK+) ≥5.5 mmol/l, not longer than 7 days apart, or (2.) a combination of one elevated sK+ and the initiation of pharmacotherapy (e.g., i.v. calcium or insulin-glucose, nebulized albuterol, potassium binders) or a diagnostic code for HK, not longer than 3 days apart. We calculated relative frequencies and incidences of HK in the overall CKD study population and specific subgroups of interest. Results 1,771,900 patients met our selection criteria for CKD, with advanced stages 3 and 4 predominantly represented (85.7% and 10.2%, respectively). The cohort consisted of 57.7% females, 83.8% Caucasian and 9.8% African American. Most common baseline comorbidities were hypertension (68.5%), hyperlipidemia (55.1%) and T2D (34.2%). 69.3% of patients were prescribed antihypertensives, 45.7% statins and 45.6% antiarrhythmics. 99.1% of patients had at least one baseline potassium measurement with values averaging 4.3 mmol/L (median, 4.3; IQR, 4.0-4.55). During an average follow up 3.9 years, 220,339 (12.4%) patients experienced at least one episode of hyperkalemia. Of those, 69.3%, 17.5%, and 13.2% showed one, two, and three or more HK episodes, respectively. Across all patients with CKD, the mean incidence rate was 3.37 (95% CI, 3.36-3.38) cases per 100 patient years (PYs). HK incidence correlated with lower eGFR and increased UACR values, with rates of 1.32 (1.25-1.39), 2.48 (2.40-2.55), 3.00 (2.99-3.01) and 8.80 (8.71-8.88) cases/100 PYs for patients with CKD stage 1, stage 2, stage 3 and stage 4, respectively. Highest incidence rates (13.81; 12.96-14.70) were found in patients with UACR values ≥3500, irrespective of their eGFR value. In addition, across disease-related subgroups, significantly higher incidence rates were found in patients co-diagnosed with T2D (5.43; 95% CI, 5.40-5.47) and HF (8.70; 8.62-8.77), and sMRA users (7.66; 7.57-7.76) at baseline. Conclusion Our contemporary findings demonstrate that HK is common in patients with CKD undergoing routine clinical care in the US, and it is notable in patients with reduced eGFR and elevated UACR. In addition, HK was more predominant in patients with T2D, heart failure or sMRA use, emphasizing a need for more routine sK+ monitoring in patients with these risk factors. Further research is needed to assess additional intrinsic risks, clinical consequences and management approaches of HK in patients with CKD to further inform clinical practice.