Abstract
BACKGROUND: Finerenone, a non-steroidal mineralocorticoid receptor antagonist, reduces renal risks in type 2 diabetic nephropathy, but its use in immunoglobulin nephropathy (IgAN) lacks evidence. This study assessed the safety and efficacy of 6-month finerenone treatment in IgAN patients. METHODS: This retrospective cohort study was mainly conducted in three Grade 3A hospitals. Patients diagnosed with IgAN and receiving standard supportive care were included. Participants were divided into the renin-angiotensin system inhibitor (RASI) and RASI + finerenone groups. The primary outcome was the percentage decrease in protein-to-creatinine ratio (PCR) over 6 months following the index study visit. RESULTS: In total, 178 patients were included in the analysis. PCR was reduced by 45.1% in the RASI + finerenone group and 32.5% in the RASI group (P = .013). Compared with 18 patients (20.2%) in the control group, 33 (37.1%) had residual PCR reduced to <0.3 g/g. After 6 months, serum potassium increased by 0.17 mmol/L from baseline, with no uncontrollable hyperkalemia (persistent serum potassium >5.5 mmol/L despite treatment). In addition, one patient presented with a blood pressure <90/60 mmHg without significant clinical symptoms in the RASI + finerenone group. And eGFR decreased by 1.94 ± 6.73 mL/min/1.73 m(2) from baseline, but not statistically significant. There were no differences in the incidence of adverse events between the two groups. CONCLUSIONS: Finerenone added to optimized RAS blocker therapy significantly reduced PCR in IgAN patients, and its safety profile was consistent with previous reports, suggesting the need for long-term renal outcome studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT06460987.