Longitudinal kidney outcomes and safety after finerenone initiation in patients with non-diabetic chronic kidney disease: a single-center retrospective cohort study
- 1Department of Nephrology (Fujian Provincial Clinical Research Center for Glomerular Nephritis), The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University , ,
- 2The School of Clinical Medicine, Fujian Medical University , ,
Abstract
Background: Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has demonstrated renoprotective effects in randomized controlled trials. However, real-world evidence, particularly in heterogeneous and non-diabetic chronic kidney disease (CKD) populations, remains limited.
Methods: This was a single-center, retrospective, real-world cohort study of adults with non-diabetic CKD who initiated finerenone. Longitudinal changes in urinary albumin-to-creatinine ratio (UACR) and 24 h urinary protein (24 hUP) were analyzed using covariate-adjusted gamma-log generalized estimating equation (GEE) models with an autoregressive correlation structure of order 1 [AR(1)] and robust standard errors, whereas eGFR trajectories were evaluated using a covariate-adjusted segmented linear mixed-effects model. The UACR and 24 hUP models were adjusted for age, sex, RASi use, SGLT−2i use, and immunosuppressant use; the eGFR model additionally included baseline UACR category. Subgroup heterogeneity was assessed using interaction tests, with Benjamini–Hochberg false discovery rate correction.
Results: Among 121 patients, finerenone initiation was associated with reductions in UACR and 24 hUP. The adjusted changes in UACR were −48.6% at Month 12 (95% CI, −60.1% to −33.8%; P < 0.001) and −35.4% at Month 24 (95% CI, −63.4% to 14.0%; P = 0.132). The corresponding adjusted changes in 24 hUP were −34.5% (95% CI, −47.3% to −18.6%; P < 0.001) and −34.9% (95% CI, −56.6% to −2.4%; P = 0.038), respectively. The annualized eGFR slope attenuated from −6.51 mL/min/1.73 m2/year (95% CI, −9.70 to −3.31) before finerenone initiation to −1.44 mL/min/1.73 m2/year (95% CI, −3.52 to 0.64) after initiation, corresponding to a slope improvement of 5.07 mL/min/1.73 m2/year (95% CI, 1.86 to 8.27; P = 0.002). No serious adverse events were documented during follow-up; hyperkalemia occurred in 4.96% of patients, and neither hyperkalemia nor hypotension prompted treatment discontinuation.
Conclusion: In this real-world cohort, finerenone was associated with reductions in UACR and 24 hUP and attenuation of eGFR decline, with infrequent observed hyperkalemia and hypotension during the available follow-up.
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BibTeX
@article{sun2026longitudinal,
title = {{Longitudinal kidney outcomes and safety after finerenone initiation in patients with non-diabetic chronic kidney disease: a single-center retrospective cohort study}},
author = {Xuejuan Sun and Juan Pei and Xing Chen and Zhi Wang and Lijing Yao and Peijin Bai and Zhiwen Yan and Yinan Li and Leping Shao},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1959259},
url = {https://europepmc.org/article/PMC/PMC13724480},
note = {CC BY},
}
RIS
TY - JOUR
TI - Longitudinal kidney outcomes and safety after finerenone initiation in patients with non-diabetic chronic kidney disease: a single-center retrospective cohort study
AU - Xuejuan Sun
AU - Juan Pei
AU - Xing Chen
AU - Zhi Wang
AU - Lijing Yao
AU - Peijin Bai
AU - Zhiwen Yan
AU - Yinan Li
AU - Leping Shao
PY - 2026
DA - 2026/10/19
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1959259
UR - https://europepmc.org/article/PMC/PMC13724480
AB - Background: Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has demonstrated renoprotective effects in randomized controlled trials. However, real-world evidence, particularly in heterogeneous and non-diabetic chronic kidney disease (CKD) populations, remains limited. Methods: This was a single-center, retrospective, real-world cohort study of adults with non-diabetic CKD who initiated finerenone. Longitudinal changes in urinary albumin-to-creatinine ratio (UACR) and 24 h urinary protein (24 hUP) were analyzed using covariate-adjusted gamma-log generalized estimating equation (GEE) models with an autoregressive correlation structure of order 1 [AR(1)] and robust standard errors, whereas eGFR trajectories were evaluated using a covariate-adjusted segmented linear mixed-effects model. The UACR and 24 hUP models were adjusted for age, sex, RASi use, SGLT−2i use, and immunosuppressant use; the eGFR model additionally included baseline UACR category. Subgroup heterogeneity was assessed using interaction tests, with Benjamini–Hochberg false discovery rate correction. Results: Among 121 patients, finerenone initiation was associated with reductions in UACR and 24 hUP. The adjusted changes in UACR were −48.6% at Month 12 (95% CI, −60.1% to −33.8%; P < 0.001) and −35.4% at Month 24 (95% CI, −63.4% to 14.0%; P = 0.132). The corresponding adjusted changes in 24 hUP were −34.5% (95% CI, −47.3% to −18.6%; P < 0.001) and −34.9% (95% CI, −56.6% to −2.4%; P = 0.038), respectively. The annualized eGFR slope attenuated from −6.51 mL/min/1.73 m2/year (95% CI, −9.70 to −3.31) before finerenone initiation to −1.44 mL/min/1.73 m2/year (95% CI, −3.52 to 0.64) after initiation, corresponding to a slope improvement of 5.07 mL/min/1.73 m2/year (95% CI, 1.86 to 8.27; P = 0.002). No serious adverse events were documented during follow-up; hyperkalemia occurred in 4.96% of patients, and neither hyperkalemia nor hypotension prompted treatment discontinuation. Conclusion: In this real-world cohort, finerenone was associated with reductions in UACR and 24 hUP and attenuation of eGFR decline, with infrequent observed hyperkalemia and hypotension during the available follow-up.
SN - 2296-858X
ER -