Qiu Dan-Dan, Liu Jing, Chen Rui-Han, Zhang Feng, An Yu, Jiang Song
National Clinical Research Center for Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
National Clinical Research Center for Kidney Diseases, Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
Clin Kidney J. 2025 Jun 4;18(6):sfaf157. doi: 10.1093/ckj/sfaf157. eCollection 2025 Jun.
This study aims to evaluate the efficacy and safety of finerenone in the treatment of obesity-related glomerulopathy (ORG).
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).
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, = .019] and higher baseline proteinuria [1.72 (1.23, 2.63) vs. 1.32 (1.12, 1.66) g/24 h, = .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%, = .010) and systolic blood pressure (-10.07 vs. -4.44 mmHg, = .045), along with a more stable eGFR (2.85% vs. -8.20%, = .009) compared with the control group. Additionally, serum potassium levels increased more in the finerenone group (8.09% vs. 1.73%, = .005). No significant difference in adverse events were observed between the groups.
Finerenone is associated with reduced proteinuria, lower blood pressure, and stabilized eGFR in patients with ORG, without a significant increase in adverse events.
本研究旨在评估非奈利酮治疗肥胖相关性肾小球病（ORG）的疗效和安全性。
对2022年1月至2023年7月期间诊断为ORG的69例患者进行回顾性分析，其中30例接受非奈利酮治疗（10 - 20毫克/天）。
该队列的平均年龄为44.30±11.43岁，包括54名男性。中位体重指数（BMI）为31.18（28.89，33.68）千克/平方米，中位24小时蛋白尿水平为1.35（1.2，1.86）克/24小时，平均估算肾小球滤过率（eGFR）为87.39±28.41毫升/分钟/1.73平方米，平均血清钾水平为4.01±0.33毫摩尔/升。所有患者均随访超过1年。与对照组相比，非奈利酮组的基线BMI较低[29.86（28.66，32.91）与31.67（30.18，34.56）千克/平方米，P = 0.019]，基线蛋白尿较高[1.72（1.23，2.63）与1.32（1.12，1.66）克/24小时，P = 0.007]。肾素 - 血管紧张素系统（RAS）抑制剂、钠 - 葡萄糖协同转运蛋白2（SGLT2）抑制剂、胰高血糖素样肽 - 1（GLP - 1）受体激动剂和他汀类药物的使用在两组之间无显著差异。在1年随访时，与对照组相比，非奈利酮组的24小时蛋白尿显著降低（-35.03%对-11.20%，P = 0.010），收缩压降低（-10.07对-4.44毫米汞柱，P = 0.045），同时eGFR更稳定（2.85%对-8.20%，P = 0.009）。此外，非奈利酮组的血清钾水平升高更多（8.09%对1.73%，P = 0.005）。两组之间不良事件无显著差异。
非奈利酮与ORG患者蛋白尿减少、血压降低和eGFR稳定相关，且不良事件无显著增加。
