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Overactivation of the mineralocorticoid receptor (MR) plays a crucial role in kidney damage by promoting inflammation, fibrosis, and functional deterioration. Finerenone, a third\u2010generation highly selective non\u2010steroidal MR antagonist (MRA), has emerged as a promising therapeutic option for CKD. In this review, we discuss the mechanisms through which MR overactivation contributes to renal damage, the structural and pharmacokinetic characteristics of finerenone, and compare it with first\u2010 and second\u2010generation MRAs. We also focus on the safety and efficacy of finerenone in clinical applications for CKD. Notably, finerenone demonstrated a reduction in the risk of hyperkalemia during treatment, with its high selectivity minimising treatment\u2010related hormonal imbalances, offering a novel perspective. Furthermore, we explore the promising future of finerenone in both diabetic kidney disease (DKD) and non\u2010diabetic CKD, presenting updates from recent clinical trials and new insights into its potential role in these populations. In clinical practice, combining finerenone with sodium\u2010glucose cotransporter\u20102 (SGLT\u20102) inhibitors and renin\u2010angiotensin system (RAS) inhibitors has demonstrated strong cardiorenal protective effects. However, further clinical evidence is needed regarding direct combinations of finerenone with RAS inhibitors. Future studies on their synergistic effects may provide valuable insights. Ultimately, we hope this review offers new perspectives on finerenone's clinical applications and its future therapeutic prospects.<\/jats:p>","DOI":"10.1002\/dmrr.70075","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T17:09:12Z","timestamp":1754500152000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Finerenone in Chronic Kidney Disease: A Comprehensive Review of Mechanisms, Efficacy and Safety"],"prefix":"10.1002","volume":"41","author":[{"given":"Yonglu","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism The Affiliated Hospital of Qingdao University  Qingdao China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengqian","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The Affiliated Hospital of Qingdao University  Qingdao 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