The Efficacy of Finerenone for Non-Diabetic Kidney Disease: A Real-World Retrospective Study

Background The purpose of this study was to evaluate the efficacy and safety of finerenone in patients with non-diabetic kidney disease. Methods This was a single-center retrospective study. The study included adults with non-diabetic kidney disease who were treated with finerenone between January 2023 and December 2025 and followed for at least 90 days. Results In this study of 122 patients, finerenone significantly reduced proteinuria, with a 34.46% median reduction in 24-hour urine protein (p < 0.001) and a decline in the urine albumin-to-creatinine ratio (ACR) from 585.99 mg/g to 295.68 mg/g at Month 24 (p = 0.006). The proportion of patients achieving a ≥ 50% reduction in proteinuria increased significantly to 45.00% by Month 24, with consistent efficacy observed in the subgroup not receiving immunosuppressive therapy. The estimated glomerular filtration rate (eGFR) trajectory showed an initial transient improvement at Month 6, followed by a later decline that subsequently stabilized. Hyperkalemia (serum potassium ≥ 5.5 mmol/L) occurred in 4.92% of patients, was manageable, and did not lead to treatment discontinuation. Conclusion Finerenone effectively reduced proteinuria in patients with non-diabetic kidney disease, with early efficacy that was maintained irrespective of immunosuppressive co-therapy. Treatment was associated with a manageable safety profile.