Efficacy and safety of finerenone in obesity-related glomerulopathy.

Background: This study aims to evaluate the efficacy and safety of finerenone in the treatment of obesity-related glomerulopathy (ORG).

Methods: A retrospective analysis was conducted on 69 patients diagnosed with ORG between January 2022 and July 2023, of whom 30 received finerenone (10-20 mg/day).

Results: The cohort had a mean age of 44.30 ± 11.43 years, comprising 54 males. The median body mass index (BMI) was 31.18 (28.89, 33.68) kg/m², the median 24-hour proteinuria level was 1.35 (1.2, 1.86) g/24 h, the mean estimated glomerular filtration rate (eGFR) was 87.39 ± 28.41 ml/min/1.73 m², and the mean serum potassium level was 4.01 ± 0.33 mmol/l. All patients were followed for over 1 year. Compared to the control group, the finerenone group had a lower baseline BMI [29.86 (28.66, 32.91) vs. 31.67 (30.18, 34.56) kg/m², P = .019] and higher baseline proteinuria [1.72 (1.23, 2.63) vs. 1.32 (1.12, 1.66) g/24 h, P = .007]. The utilization of renin-angiotensin system (RAS) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and statins showed no significant differences between the groups. At 1-year follow-up, the finerenone group demonstrated significantly greater reduction in 24-hour proteinuria (-35.03% vs. -11.20%, P = .010) and systolic blood pressure (-10.07 vs. -4.44 mmHg, P = .045), along with a more stable eGFR (2.85% vs. -8.20%, P = .009) compared with the control group. Additionally, serum potassium levels increased more in the finerenone group (8.09% vs. 1.73%, P = .005). No significant difference in adverse events were observed between the groups.

Conclusions: Finerenone is associated with reduced proteinuria, lower blood pressure, and stabilized eGFR in patients with ORG, without a significant increase in adverse events.