Finerenone, a Non-steroidal Mineralocorticoid Receptor Antagonist, in Diabetic Kidney Disease: A Systematic Review

Abstract

Introduction: Patients with diabetic kidney disease (DKD) have a high residual risk of kidney failure and cardiovascular events despite standard therapy with RAS inhibitors. Finerenone is a novel, non-steroidal mineralocorticoid receptor antagonist (MRA) with potent anti-inflammatory and anti-fibrotic properties.

Methods: A search for large-scale RCTs was performed. We included studies comparing finerenone to placebo in patients with DKD already receiving standard care. The primary outcome was a composite of kidney failure, sustained eGFR decline, or renal death.

Results: The review of two major CVOTs showed that finerenone significantly reduced the risk of the primary composite renal outcome compared to placebo. It also significantly lowered the risk of key secondary cardiovascular outcomes. The risk of hyperkalemia was present but manageable.

Discussion: Unlike steroidal MRAs, finerenone has a higher affinity for the MR and a more favorable side-effect profile, particularly regarding hyperkalemia and gynecomastia. It targets inflammation and fibrosis, key drivers of DKD progression.

Conclusion: Finerenone is an effective therapy for reducing the risk of both kidney and cardiovascular events in patients with diabetic kidney disease.