Safety and Efficacy of Finerenone in Chronic Kidney Disease (CKD) Patients

Abstract

Background: Finerenone is a selective non-steroidal mineralocorticoid receptor antagonist with established kidney and cardiovascular benefits in chronic kidney disease (CKD) associated with type 2 diabetes. Short-term real-world data from broader CKD populations, including non-diabetic CKD, remain less extensive. We evaluated renal responses and safety during routine nephrology care.

Methods: We conducted a prospective, observational, single-centre study in adults aged 18–75 years with CKD stages 1–4 and significant albuminuria/proteinuria. Twenty-eight eligible participants receiving or initiated on finerenone were followed at baseline and at 1, 3 and 6 months. Finerenone was used at 10–20 mg once daily with dose adjustment according to eGFR and serum potassium. Primary outcomes were longitudinal changes in eGFR and urine albumin-to-creatinine ratio (uACR); treatment-emergent adverse events were the principal safety outcome. Descriptive subgroup analyses compared diabetic and non-diabetic CKD.

Results: All 28 participants had recorded renal measurements at 1, 3 and 6 months. Mean eGFR increased from 45.5 ± 25.1 mL/min/1.73 m² at baseline to 54.8 ± 24.2 at 1 month, 55.9 ± 24.2 at 3 months and 55.4 ± 24.6 at 6 months; the mean 6-month change was 9.9 mL/min/1.73 m² (95% CI 5.7–14.2; p < 0.001). Median uACR decreased from 1040.0 mg/g (IQR 619.8–1485.8) to 313.5 mg/g (IQR 137.0–387.2), a 69.9% reduction in cohort medians. At 6 months, 25 participants (89.3%) had an increase in eGFR from baseline, and 19 (67.9%) had a patient-level uACR reduction of at least 30% in an exploratory analysis. Treatment-emergent adverse events were recorded in 18 participants (64.3%); hyperkalemia was recorded in 7 (25.0%), and 5 (17.9%) had maximum follow-up potassium ?5.5 mmol/L. Hypotension occurred in 4 (14.3%) and renal deterioration/mild eGFR decline in 2 (7.1%). No cardiovascular composite event or hospitalization was documented.

Conclusions: In this small, uncontrolled observational cohort, finerenone exposure was associated with progressive reduction in albuminuria and an observed increase in mean eGFR over 6 months. Hyperkalemia and haemodynamic events remained clinically relevant and support structured monitoring. The findings are hypothesis-generating and cannot establish causality or long-term cardiorenal benefit.