#2054 Observation of the therapeutic effect of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, in patients with non-diabetic CKD

Abstract Background and Aims Finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), has anti-fibrotic and anti-inflammatory properties. Two clinical studies have demonstrated that finerenone can slow the progression of chronic kidney disease (CKD) and decrease cardiovascular events in CKD linked with diabetes. However, studies assessing CKD patients without diabetes are scarce. Further research is required to determine the safety and effectiveness of finerenone in the real-world setting for this demographic. Method This retrospective, single-center real-world study assessed non-diabetic CKD patients >18 years old administered finerenone at Xi'an Jiao Tong University's First Affiliated Hospital between January 2023 and August 2023. The primary study indicators were estimated glomerular filtration rate (eGFR), 24-hour urine protein, serum potassium (sK+), and serum albumin. Follow-up for six months was performed to assess finerenone's safety and effectiveness. Results (1) 78 patients proved eligible. The effective rate was 61.5% (n = 48) and the average age was 41.53 ± 12.54 years, including 50 (64.1%) men. Totally 34 (43.6%) cases had cardiovascular disease. After treatment, the average age of the 48 effective cases was 44.33 ± 12.75 years, with 31 (64.6%) males and 20 (41.7%) cardiovascular disease cases. (2) Among effective patients, the average 24-hour proteinuria was 1.71 ± 0.32 g/d, and the average eGFR was 88.34 ± 4.48 ml/min/1.73 m2 at baseline. After treatment, the average 24-hour proteinuria was significantly decreased, the average eGFR briefly decreased, the average sK+ fluctuated only slightly, and the average serum albumin gradually increased. At 3 and 6 months after finerenone initiation, average proteinuria levels were 0.64 ± 0.14 g/d (P = 0.002) and 0.55 ± 0.14 g/d (P < 0.001), average percentage changes from baseline were −63% and −68%, respectively; mean eGFR were 82.09 ± 4.69 ml/min/1.73 m2 (P = 0.016) and 87.05 ± 6.21 ml/min/1.73 m2 (P = 0.759), respectively. The average sK+ were 4.23 ± 0.07 mmol/L, 4.46 ± 0.07 mmol/L (P = 0.003), 4.41 ± 0.08 mmol/L (P = 0.041), at baseline and 3 and 6 months, respectively. The average serum albumin were 39.17 ± 0.93 g/L, 41.80 ± 0.70 g/L (P = 0.005), 42.24 ± 0.70 g/L (P = 0.003) at baseline and 3 and 6 months, respectively. (3) The half of IgAN cases (n = 20) achieved proteinuria relief. (4) During finerenone treatment, combination with RASi alone, SGLT2i alone or RASi + SGLT2i resulted in higher efficacy versus cases not administered these drugs (effective rates of 64%, 60%, 63% vs 50%, respectively), but the difference was not statistically significant (χ² = 0.664, P = 0.952). (5) Adverse effects were minimal. Conclusion Finerenone can effectively decrease proteinuria in patients with non-diabetic CKD, with little impacts on eGFR and sK+. Its efficacy does not depend on concurrent use of RASi and SGLT2i. It is expected to confer proteinuria remission in IgAN. However, given the limited sample size, more comprehensive prospective studies and real-world research are needed to corroborate the results of this study.