Efficacy and Safety of Finerenone in Nondiabetic Nephropathy: A Real-World Retrospective Study

Background: Finerenone has gained significant attention due to its anti-inflammatory and anti-fibrosis mechanisms. Finerenone has been shown to significantly reduce UACR and effectively delay the deterioration of renal function in patients with diabetes-related CKD. However, the evidence of its efficacy and safety in non-diabetic CKD remains limited. Therefore, this study aimed to retrospectively analyze the clinical data of non-diabetic CKD patients treated with finerenone in a real-world setting, and to evaluate its patient-specific efficacy and safety. Methods: In this study, we enrolled a total of 91 patients with non-diabetic kidney disease（aged 18-80 years eGFR≥25 mL/min/1.73 m2）from December 2022 to April 2024. Patients were followed for 12 months after treatment with finerenone. Data were collected at baseline and monthly thereafter to assess renal function changes. Results: There were 59 males (64.8%) and 32 females (35.2%), with a mean age of 48.86 ±13.08 years.The baseline level of proteinuria of the enrolled patients was 0.76 [0.45, 1.49] g/day, the baseline estimated glomerular filtration rate (eGFR) level was 64.47 ± 23.04 mL/min/1.73 m2 ,and the baseline serum potassium level was 4.33 ± 0.46 mmol/L.After 12 months of follow-up, there was a decrease in proteinuria compared with the baseline level, with a significant decrease in proteinuria level to 0.47 [0.20, 0.90] g/day (P=0.042) after 9 months of treatment. In addition, blood urea nitrogen, serum creatinine, and uric acid levels showed no significant fluctuations.. Similarly, eGFR remained stable throughout the 12-month period. Serum potassium levels, a key evaluation index of drug safety, increased above 5.5mmol/L in 5 patients (1 patient reached >6.0 mmol/L at 8 months). Serum potassium levels in other patients remained stable. Conclusion: These data provide preliminary evidence supporting finerenone as a therapeutic option for non-diabetic nephropathy, demonstrating its efficacy in reducing proteinuria while maintaining stable renal function and serum potassium levels. Considering the limitations of this study, larger randomized controlled trials are still needed to further validate these findings.