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July 18, 2026BMC NephrologyOpen Access

Finerenone slows annual eGFR decline by ~0.7 mL/min/1.73m² vs placebo in non-diabetic CKD.

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Why the study?

Do non-steroidal mineralocorticoid receptor antagonists (ns-MRAs) slow eGFR decline and reduce proteinuria in patients with non-diabetic kidney disease?

Population

Patients with non-diabetic kidney disease, specifically proteinuric chronic kidney disease without diabetes

Design

Review

Key result

Finerenone significantly slowed kidney function decline compared to placebo in adults with non-diabetic chronic kidney disease, with a between-group difference in eGFR slope of 0.7 mL/min/1.73 m² per year.

Authors

FLF LuoJHJu-Wu HuHFHongliang Fang

Discussion

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Member takes

Overview

May support ns-MRA consideration in selected non-diabetic proteinuric CKD; leaves open dedicated RCTs for specific glomerulopathies.

Key Points

  • This review aims to explore the role and mechanisms of non-steroidal mineralocorticoid receptor antagonists in non-diabetic kidney disease.
  • Analyzes mechanistic studies on non-steroidal mineralocorticoid receptor antagonists
  • Reviews findings from phase III FIND-CKD trial and real-world studies
  • Discusses potential interactions with sodium-glucose cotransporter 2 inhibitors
  • The FIND-CKD trial shows finerenone slows eGFR decline in proteinuric CKD patients (HR not specified).
  • Real-world studies indicate finerenone reduces proteinuria in IgA and membranous nephropathies.
  • Co-administration with SGLT2 inhibitors may enhance antiproteinuric effects, though monitoring for hyperkalemia is necessary.

Structured PICO

Do non-steroidal mineralocorticoid receptor antagonists (ns-MRAs) slow eGFR decline and reduce proteinuria in patients with non-diabetic kidney disease?

P
Population
1,584 adults with proteinuric chronic kidney disease without diabetes receiving background RAS inhibition, evaluated over 32 months.
I
Intervention
Non-steroidal mineralocorticoid receptor antagonists (ns-MRAs), such as finerenone
O
Outcome
eGFR decline and proteinuriasurrogate

Main Result

Mean Difference: 0.7

Absolute Event Rate: -3.3% vs -4%

p-value: p=<0.001

Non-steroidal MRAs such as finerenone demonstrate multi-level protective effects and slow eGFR decline in non-diabetic proteinuric kidney disease, expanding their therapeutic role.

Limitations

  • Hyperkalemia remains an important safety consideration requiring appropriate monitoring.
  • No head-to-head randomized controlled trials have directly compared steroidal and non-steroidal MRAs specifically in NDKD populations.
  • Observational studies in specific NDKD subtypes (like IgAN and MN) require cautious interpretation due to their nonrandomized designs.

Cite This Study

Luo et al. (2026) conducted a review in Non-diabetic chronic kidney disease (n=1,584). Finerenone vs. Placebo was evaluated on Total eGFR slope (mean annual rate of change in eGFR from baseline to month 32) (MD 0.7, p=<0.001). Finerenone significantly slowed kidney function decline compared to placebo in adults with non-diabetic chronic kidney disease, with a between-group difference in eGFR slope of 0.7 mL/min/1.73 m² per year.

synapsesocial.com/papers/6a5b39118167787360d24f0dhttps://doi.org/10.1186/s12882-026-05205-4
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