Abstract
OBJECTIVE: To evaluate the efficacy and safety of finerenone in patients with IgA nephropathy (IgAN). METHODS: This retrospective study included 105 patients with IgAN (35 in the finerenone group, 70 in the control group) from January 2022 to February 2025. The finerenone group received conventional therapy plus finerenone, while the controls received conventional therapy alone. Outcomes included 24-h urinary protein (UP24), estimated glomerular filtration rate (eGFR), and adverse events (AEs). Propensity score matching (PSM) was used to balance baseline characteristics (28 patients/group). RESULTS: After 1:1 PSM, the finerenone group demonstrated a sustained reduction in UP24, from 742 ± 519 mg at baseline to 380 ± 333 mg (p < 0.001), while the control group showed no significant improvement at 12 months (p = 0.402). A similar trend of proteinuria reduction was observed at 3 and 6 months in the finerenone group. The between-group difference in ΔUP24 was significant at 12 months (finerenone: -393 ± 506 mg vs. control: +235 ± 1114 mg, p = 0.027). Finerenone demonstrated better preservation of eGFR at 12 months compared to controls after matching (ΔeGFR: +3.43 ± 8.25 vs. -5.99 ± 7.31 mL/min/1.73 m(2), p < 0.001). Safety profiles, including the incidence of hyperkalemia, elevated ALT, hypotension, and overall AEs, were comparable between the groups. CONCLUSIONS: Finerenone significantly reduced proteinuria and preserved eGFR in patients with IgAN over 12 months, with a favorable safety profile, suggesting potential benefit as an adjunctive treatment, pending randomized controlled trial confirmation. This study provides real-world, hypothesis-generating evidence for finerenone in IgAN, which can inform future RCT design and meta-analyses.