Objective:

To explore renal outcomes in patients with glomerular disease receiving finerenone compared to placebo in a randomized, double-blind trial.

Key Findings:

• eGFR decline was −3.50 mL/min/1.73 m² per year with finerenone vs −4.23 mL/min/1.73 m² per year with placebo, indicating a significant difference.
• Kidney failure or sustained eGFR decline occurred at rates of 7.42 vs 9.60 events per 100 patient-years for finerenone and placebo, respectively.
• Finerenone reduced urinary albumin-to-creatinine ratio by 47% in the immunoglobulin A nephropathy subgroup.
• Serious adverse events occurred in 20% of finerenone and 21% of placebo participants.

Interpretation:

Finerenone may attenuate chronic eGFR decline in patients with glomerular diseases, particularly in those with immunoglobulin A nephropathy.

Limitations:

• The analysis was exploratory and not powered for time-to-event outcomes.
• Kidney disease etiology was based on investigator-reported diagnoses, with limited biopsy confirmation, which may affect the reliability of the findings.
• Exclusion of patients receiving immunosuppressive therapy may limit generalizability of the results.

Conclusion:

Finerenone shows potential in altering the trajectory of glomerular disease, particularly in immunoglobulin A nephropathy, but further studies are needed to confirm these findings.