Efficacy and safety of finerenone in non-diabetic chronic kidney disease
a systematic review and meta-analysis.
A systematic review and meta-analysis demonstrates that finerenone significantly slows eGFR decline in patients with non-diabetic chronic kidney disease (difference in slope +0.70 mL/min/1.73m²/year; P < 0.001) and roughly quadruples the odds of achieving a ≥ 30% reduction in proteinuria (OR 3.99). Hyperkalaemia was more frequent with finerenone (17.0% vs 13.3%), but overall adverse events and discontinuation rates remained low. These findings support finerenone as a kidney-protective option for non-diabetic CKD, highlighting the need for routine potassium monitoring.
Objectives
Finerenone, a non-steroidal mineralocorticoid receptor antagonist (nsMRA), reduces composite kidney, and cardiovascular endpoints in diabetic CKD. Its efficacy and safety across non-diabetic CKD aetiologies remain uncharacterised in prior meta-analyses.
Methods
Four databases were searched to May 2026. RCTs and observational studies enrolling adults with non-diabetic CKD receiving finerenone were eligible. Two streams were used: Stream A (single-arm) and Stream B (comparative, finerenone vs. controls). The primary outcomes were eGFR slope/12-month change and proteinuria reduction; safety outcomes were hyperkalaemia, hypotension, adverse events, and discontinuation. Random-effects models (Hartung-Knapp), ROB-2, Newcastle-Ottawa Scale, GRADE, and TSA were applied.
Results
Nine studies (N = 2020) met eligibility, including two RCTs (the placebo-controlled FIND-CKD trial (n = 1584) and an open-label crossover pilot), alongside seven observational studies. Finerenone significantly slowed eGFR decline in the RCT (slope difference +0.70 mL/min/1.73m2/year, 95%CI 0.30-1.10; P < 0.001) and increased odds of a ≥ 30% proteinuria response roughly four-fold (pooled OR 3.99, 95% CI 1.91-8.30; P = 0.027). Two propensity-matched IgAN cohorts showed a 76.8% reduction in proteinuria versus controls (95% CI -81.1% to -72.6%; I2 = 0%). In single-arm analysis, 28.9% achieved a ≥ 50% proteinuria reduction. Hyperkalaemia was more frequent with finerenone (17.0% vs 13.3%; OR 1.34, 95% CI 1.02-1.76), though any adverse event did not differ (OR 1.15, 95% CI 0.67-1.99); pooled hyperkalaemia was 1.6%, hypotension 0.5%, discontinuation 0/258.
Conclusions
In non-diabetic CKD, finerenone slows eGFR decline, supported by high-certainty evidence from FIND-CKD, and reduces proteinuria, with a modest rise in hyperkalaemia. These data support finerenone as a kidney-protective, proteinuria-lowering therapy, underscoring the need for potassium monitoring, and further trials.
Join us
Join the Global Primary Care Cardio Network. Membership is free.
Would you like to tell us more about yourself?
Interests
We will send you an email with a link to confirm your registration.
