Effectiveness and safety of finerenone in Chinese CKD patients without diabetes: a retrospective, real-world study

Abstract Background Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has previously demonstrated its efficacy and safety in chronic kidney disease (CKD) associated with diabetes mellitus. Given its therapeutic potential, finerenone has been preliminarily explored in clinical practice for non-diabetic CKD patients. The effectiveness and safety in this population require further investigation in a real-world setting. Methods This retrospective, real-world analysis included non-diabetic CKD patients receiving finerenone. The main clinical outcomes assessed were changes in urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Serum potassium (sK + ) levels were also monitored. Data were collected at baseline, and then at 1 month and 3 months following treatment initiation. Results Totally, 16 patients were included. There was a notable decrease in UACR from 1-month post-treatment, with a further reduction at 3 months, resulting in a median reduction of 200.41 mg/g (IQR, 84.04–1057.10 mg/g; P = 0.028; percent change, 44.52% [IQR, 31.79–65.42%]). The average eGFR at baseline was 80.16 ml/min/1.73m 2 , with no significant change after 1 month (80.72 ml/min/1.73m 2 , P = 0.594) and a slight numerical increase to 83.45 ml/min/1.73m 2 ( P = 0.484) after 3 months. During the 3-month follow-up, sK + levels showed only minor fluctuations, with no significant differences compared to baseline, and remained within the normal range throughout the treatment period. No treatment discontinuation or hospitalization due to hyperkalemia was observed. Conclusion In non-diabetic CKD patients, finerenone showed good effectiveness and safety within a 3-month follow-up period. This study provides valuable real-world evidence supporting the use of finerenone in non-diabetic CKD and highlights the need for future large-scale prospective research to further validate its efficacy.