Observation of the therapeutic effect of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, in patients with non-diabetic CKD

Abstract

Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, exhibits anti-fibrotic and anti-inflammatory properties. While numerous studies have demonstrated its efficacy in reducing kidney and cardiovascular events in diabetic kidney disease, data on non-diabetic chronic kidney disease (CKD) remain limited. This retrospective study evaluated the safety and efficacy of finerenone in adult patients with non-diabetic CKD. The primary study parameters included estimated glomerular filtration rate (eGFR), 24-h proteinuria, serum potassium (sK+), and serum albumin. A total of 78 patients met the eligibility criteria. Following finerenone treatment, the overall efficacy rate was 61.5% (n = 48). Among responders, 24-h proteinuria significantly decreased (1.71 ± 0.32 g/d at baseline, 0.64 ± 0.14 g/d at 3 months, and 0.55 ± 0.14 g/d at 6 months), while eGFR showed a transient decline (88.34 ± 4.48 mL/min/1.73 m2 at baseline, 82.09 ± 4.69 mL/min/1.73 m2 at 3 months, and 87.05 ± 6.21 mL/min/1.73 m2 at 6 months). Serum potassium fluctuated slightly (4.23 ± 0.07 mmol/L at baseline, 4.46 ± 0.07 mmol/L at 3 months, and 4.41 ± 0.08 mmol/L at 6 months), whereas serum albumin progressively increased (39.17 ± 0.93 g/L at baseline, 41.80 ± 0.70 g/L at 3 months, and 42.24 ± 0.70 g/L at 6 months). Among patients with IgA nephropathy (IgAN), 50% (n = 20) achieved proteinuria reduction. Adverse effects were minimal. Finerenone effectively reduced proteinuria in non-diabetic CKD patients with minimal impact on eGFR and sK+, supporting its efficacy and safety in real-world clinical practice in China.