A retrospective cohort study of 382 patients with non-diabetic IgA nephropathy demonstrates that finerenone significantly improves complete renal remission rates (HR 2.58; p < 0.001) and reduces the risk of a ≥30% eGFR decline (HR 0.30; p = 0.036) compared to standard care alone. Potassium levels remained stable, and adding finerenone to an SGLT2 inhibitor yielded the highest remission rates. These findings support the nephroprotective role of finerenone in non-diabetic IgA nephropathy, particularly when combined with SGLT2 inhibitors.
Finerenone has been proven to have cardiovascular and renal protective effects on chronic kidney disease associated with type 2 diabetes. However, the therapeutic effect of finerenone on IgA nephropathy (IgAN) without diabetes remains unclear.
A retrospective analysis was conducted on patients with primary IgAN who received standard treatment between September 2023 and June 2025. The patients were divided into the finerenone and control groups based on whether finerenone was used. The primary outcomes were the renal complete response (CR) rate (<0.5 g/day) and renal endpoint events [defined as a 30% reduction in estimated glomerular filtration rate (eGFR)], and the secondary outcomes were the degree of decrease in 24-h urine protein quantification, changes in eGFR and safety outcomes.
A total of 382 patients were included (191 in the finerenone group and 191 in the control group). Finerenone significantly increased the CR rate compared with the control group [hazard ratio (HR) 2.58, 95% confidence interval (CI) 1.82-3.66, P < .001] and reduced the renal endpoint event (HR 0.30, 95% CI 0.07-0.91, P = .036). Finerenone combined with sodium-glucose cotransporter 2 inhibitors (SGLT2i) had a higher renal remission rate (with SGLT2i: HR 3.52, 95% CI 2.32-5.35; without SGLT2i: HR 1.54, 95% CI 0.75-3.19, Pinteraction = .032). The serum potassium levels in both groups remained consistent.
Finerenone is safe and effective in treating IgAN patients without diabetes, and finerenone combined with SGLT2i has a higher CR rate.
