Ramadan Mahmoud M, Alajmi Shaha, Aldouseri Jude, Alajmi Manar, Tello Eva A, Mahdi Abdul-Majeed O, Aladwani Ahmad J, Alayyaf Abdulrahman E, Mahdi Ousama, Elmahal Mohammed
Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, EGY.
Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, ARE.
Cureus. 2025 Jul 11;17(7):e87706. doi: 10.7759/cureus.87706. eCollection 2025 Jul.
Finerenone is a novel third-generation nonsteroidal mineralocorticoid receptor antagonist (MRA) that has demonstrated efficacy in treating chronic kidney disease (CKD) and heart failure with reduced ejection fraction (HFrEF). Unlike traditional steroidal MRAs such as Spironolactone and Eplerenone, Finerenone offers high selectivity for MR, resulting in reduced off-target effects, including hyperkalemia and antiandrogenic side effects. It exerts renoprotective and cardioprotective effects through its anti-inflammatory and antifibrotic actions, making it a good therapeutic option for patients with CKD and HFrEF. The pharmacokinetic profile of Finerenone demonstrates rapid absorption, satisfactory oral bioavailability, and predictable systemic clearance, contributing to its efficacy and tolerability. Clinical trials, including advanced Phase III studies, have established Finerenone's ability to delay CKD progression, reduce proteinuria, and improve cardiovascular (CV) outcomes (such as hospitalization for heart failure and CV death) in patients with diabetes mellitus and CKD. Compared to other MRAs, Finerenone demonstrates improved tolerability; however, clinically significant risks such as hyperkalemia necessitate proactive monitoring and protocol-driven management. Additionally, its unique molecular structure and mechanism of action make it a safer alternative for long-term use in diverse populations. While initial results are promising, further research is necessary to evaluate the long-term outcomes and explore its full therapeutic potential, including novel applications in high-risk patients and biomarker-driven treatments. These findings position finerenone as a valuable addition to current therapies for CKD and HFrEF, though broader adoption awaits real-world validation of its safety and cost-effectiveness.
非奈利酮是一种新型的第三代非甾体类盐皮质激素受体拮抗剂（MRA），已证明其在治疗慢性肾脏病（CKD）和射血分数降低的心力衰竭（HFrEF）方面具有疗效。与传统的甾体类MRA如螺内酯和依普利酮不同，非奈利酮对盐皮质激素受体具有高选择性，从而减少了包括高钾血症和抗雄激素副作用在内的脱靶效应。它通过抗炎和抗纤维化作用发挥肾脏保护和心脏保护作用，使其成为CKD和HFrEF患者的良好治疗选择。非奈利酮的药代动力学特征显示其吸收迅速、口服生物利用度良好且全身清除率可预测，这有助于其疗效和耐受性。包括晚期III期研究在内的临床试验已证实非奈利酮能够延缓CKD进展、减少蛋白尿，并改善糖尿病和CKD患者的心血管（CV）结局（如因心力衰竭住院和CV死亡）。与其他MRA相比，非奈利酮显示出更好的耐受性；然而，高钾血症等具有临床意义的风险需要进行主动监测和遵循方案的管理。此外，其独特的分子结构和作用机制使其成为不同人群长期使用的更安全选择。虽然初步结果令人鼓舞，但仍需要进一步研究来评估长期结局并探索其全部治疗潜力，包括在高危患者中的新应用和生物标志物驱动的治疗方法。这些发现使非奈利酮成为目前CKD和HFrEF治疗的有价值补充，不过其更广泛的应用有待对其安全性和成本效益进行真实世界验证。
