Efficacy and safety of finerenone with or without combination therapy in patients with non-diabetic chronic kidney disease: a real-world observational study

BACKGROUND: This study aimed to evaluate the efficacy and safety of finerenone, with or without combination therapy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) or renin-angiotensin system inhibitors (RASi), in Chinese patients with non-diabetic chronic kidney disease (non-diabetic CKD) at different follow-up time points. METHODS: Patients with non-diabetic CKD who received finerenone treatment from March 2023 to August 2025 were retrospectively enrolled. According to the treatment regimens, patients were divided into four groups: finerenone monotherapy group (without SGLT2i or RASi), finerenone + SGLT2i group, finerenone + RASi group, and finerenone + SGLT2i + RASi group. The main evaluated indicators included urine albumin-to-creatinine ratio (UACR), urine protein-to-creatinine ratio (UPCR), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), and serum potassium (K+) levels. RESULTS: A total of 483 patients were enrolled in this study, including 229 males (47.41%); baseline UACR was 520.1 (interquartile range [IQR], 259.2-993.9) mg/g. After receiving finerenone treatment for 18 months, the UACR decreased by 69.18%. During the study period, the change in eGFR remained stable, with only 2.48% of patients experiencing an eGFR decline >30%. Hyperkalemia occurred in only 6 patients (1.24%), indicating a good safety profile during the medication period. CONCLUSION: Finerenone can effectively reduce proteinuria in patients with non-diabetic CKD. Dual or triple combination therapy demonstrated more pronounced effects, with an overall favorable safety profile. Nevertheless, careful monitoring of short-term changes in eGFR and serum K+ levels remains essential during finerenone therapy.