{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:10:30Z","timestamp":1788952230016,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Finerenone and steroidal mineralocorticoid receptor antagonists (sMRAs) reduce proteinuria in chronic kidney disease (CKD), but direct comparative data from routine clinical practice remain limited. The objective of this study was to compare the effectiveness, hemodynamic effects, kidney function trajectory, and safety of finerenone versus sMRAs in patients with proteinuric CKD in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center cohort study included adults receiving finerenone or an sMRA between January 2021 and May 2025. Longitudinal analyses included 174 patients with at least one post-baseline assessment (finerenone, n = 96; sMRA, n = 78). Changes in proteinuria, estimated glomerular filtration rate (eGFR), blood pressure, potassium, and glycated hemoglobin were assessed using mixed-effects models. A 1:1 propensity score-matched sensitivity analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both treatments were associated with significant proteinuria reductions at 12 months, with percentage changes of \u221245.63% (95% confidence interval [CI], \u221259.42 to \u221227.15) with finerenone and \u221244.44% (95% CI, \u221260.08 to \u221222.66) with sMRAs, without a significant between-group difference (p = 0.927). Proteinuria reduction was already significant at 1 month with sMRAs, whereas it became significant from month 6 with finerenone. Both groups showed an early eGFR decline. At month 12, the decline remained significant in the sMRA group (\u22124.66\u00a0mL\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ; 95% CI, \u22127.35 to \u22121.97) but not in the finerenone group; however, no significant between-group difference in eGFR trajectory was observed. sMRAs produced a greater reduction in systolic blood pressure at 12 months than finerenone, with a between-group difference of 7.24\u00a0mmHg (95% CI, 2.25\u201317.66). Serum potassium increased in both groups without a significant between-group difference. Treatment discontinuation was less frequent with finerenone than with sMRAs (13.8% vs. 28.7%; p = 0.021). Findings for proteinuria and eGFR were consistent in the matched sensitivity analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this real-world cohort, finerenone and sMRAs showed comparable antiproteinuric effectiveness. sMRAs were associated with a more pronounced blood pressure reduction, whereas finerenone showed more favorable renal profile, with lower treatment discontinuation and side effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1918516","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:17:18Z","timestamp":1788949038000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A comparative real-world analysis of finerenone and steroidal mineralocorticoid receptor antagonists in patients with chronic kidney disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Daniele","family":"Vetrano","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Cianciolo","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Barbuto","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Ribichini","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Berti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]},{"name":"Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mistretta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Ginesi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip Timothy","family":"Millar","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amedeo","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisella","family":"Vischini","sequence":"additional","affiliation":[{"name":"UOC Nefrologia e Dialisi, Ospedale Santa Rosa (Belcolle)","place":["Viterbo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Poluzzi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uberto","family":"Pagotto","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]},{"name":"Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"La Manna","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna","place":["Bologna, Italy"]},{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Capelli","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Rehabilitation, University of Ferrara","place":["Ferrara, Italy"]},{"name":"Nephrology and Dialysis Unit, Azienda Ospedaliero-Universitaria di Ferrara","place":["Ferrara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1093\/eurheartj\/ehaa736","article-title":"Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine","volume":"42","author":"Agarwal","year":"2021","journal-title":"Eur. Heart J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1093\/eurheartj\/ehab777","article-title":"Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis","volume":"43","author":"Agarwal","year":"2022","journal-title":"Eur. Heart J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1093\/ndt\/gfaf022","article-title":"COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR endpoint (CONFIDENCE) trial: baseline clinical characteristics","volume":"40","author":"Agarwal","year":"2025","journal-title":"Nephrol. Dial. Transpl."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1056\/NEJMoa2025845","article-title":"Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes","volume":"383","author":"Bakris","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1038\/s41581-021-00490-8","article-title":"Mineralocorticoid receptor antagonists in diabetic kidney disease - mechanistic and therapeutic effects","volume":"18","author":"Barrera-Chimal","year":"2022","journal-title":"Nat. Rev. Nephrol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3382","DOI":"10.1093\/eurheartj\/ehaf316","article-title":"Finerenone effects on biomarkers: an analysis from the FIGARO-DKD trial","volume":"46","author":"Berger","year":"2025","journal-title":"Eur. Heart J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/S2213-8587(24)00309-7","article-title":"Finerenone and new-onset diabetes in heart failure: a prespecified analysis of the FINEARTS-HF trial","volume":"13","author":"Butt","year":"2025","journal-title":"Lancet Diabetes Endocrinol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.3390\/life13041061","article-title":"Impact of baseline clinical variables on SGLT2i's antiproteinuric effect in diabetic kidney disease","volume":"13","author":"Capelli","year":"2023","journal-title":"Life (Basel)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1016\/j.mayocp.2026.01.010","article-title":"Acute estimated glomerular filtration rate decline after initiation of therapies that slow kidney disease progression: clinical practice implications","volume":"21","author":"Cherney","year":"2026","journal-title":"Mayo Clin. Proc."},{"key":"B10","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1161\/CIRCULATIONAHA.124.071079","article-title":"Albuminuria in cardiovascular, kidney, and metabolic disorders: a state-of-the-art review","volume":"151","author":"Claudel","year":"2025","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12882-016-0337-0","article-title":"Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis","volume":"17","author":"Currie","year":"2016","journal-title":"BMC Nephrol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1053\/j.ajkd.2022.04.016","article-title":"Aldosterone, mineralocorticoid receptor activation, and CKD: a review of evolving treatment paradigms","volume":"80","author":"Epstein","year":"2022","journal-title":"Am. J. Kidney Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1016\/j.jacc.2025.06.012","article-title":"Aldosterone and aldosterone modulation in cardio-kidney diseases","volume":"86","author":"Fioretti","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s12933-021-01229-2","article-title":"The residual cardiorenal risk in type 2 diabetes","volume":"20","author":"Giugliano","year":"2021","journal-title":"Cardiovasc Diabetol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1056\/NEJMoa2604625","article-title":"Finerenone in persons with chronic kidney disease without diabetes","volume":"395","author":"Heerspink","year":"2026","journal-title":"N. Engl. J. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"6683987","DOI":"10.1155\/2023\/6683987","article-title":"Efficacy and safety of eplerenone for treating chronic kidney disease: a meta-analysis","volume":"2023","author":"Hu","year":"2023","journal-title":"Int. J. Hypertens."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1161\/CIRCULATIONAHA.120.050686","article-title":"Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options","volume":"143","author":"Jankowski","year":"2021","journal-title":"Circulation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","year":"2024","journal-title":"Kidney Int."},{"key":"B19","doi-asserted-by":"publisher","first-page":"12450","DOI":"10.1096\/fj.202000164R","article-title":"The novel non-steroidal MR antagonist finerenone improves metabolic parameters in high-fat diet-fed mice and activates brown adipose tissue via AMPK-ATGL pathway","volume":"34","author":"Marzolla","year":"2020","journal-title":"FASEB J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1016\/S0140-6736(26)01009-3","article-title":"Efficacy and safety of finerenone in patients with chronic kidney disease: an individual participant data pooled analysis (INFINITY)","volume":"407","author":"Neuen","year":"2026","journal-title":"Lancet"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2252","DOI":"10.1056\/NEJMoa2110956","article-title":"Cardiovascular events with finerenone in kidney disease and type 2 diabetes","volume":"385","author":"Pitt","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1681\/ASN.2022020207","article-title":"Albuminuria-lowering effect of dapagliflozin, eplerenone, and their combination in patients with chronic kidney disease: a randomized crossover clinical trial","volume":"33","author":"Provenzano","year":"2022","journal-title":"J. Am. Soc. Nephrol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"121","DOI":"10.2147\/POR.S489802","article-title":"Steroidal mineralocorticoid receptor antagonist side effects and reasons for discontinuation: a patient survey (RELICS-PS)","volume":"16","author":"Richard","year":"2025","journal-title":"Pragmat. Obs. Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/ajh\/hpx210","article-title":"Spironolactone and resistant hypertension in heart failure with preserved ejection fraction","volume":"31","author":"Rossignol","year":"2018","journal-title":"Am. J. Hypertens."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2685","DOI":"10.1161\/HYPERTENSIONAHA.122.19744","article-title":"Blood pressure and cardiorenal outcomes with finerenone in chronic kidney disease in type 2 diabetes","volume":"79","author":"Ruilope","year":"2022","journal-title":"Hypertension"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1885","DOI":"10.1093\/ckj\/sfad139","article-title":"Mineralocorticoid receptor antagonist use in chronic kidney disease with type 2 diabetes: a clinical practice document by the European Renal Best Practice (ERBP) board of the European Renal Association (ERA)","volume":"16","author":"Sarafidis","year":"2023","journal-title":"Clin. Kidney J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/ajh\/hpae071","article-title":"Association between plasma aldosterone concentration and intraglomerular hemodynamics in primary aldosteronism","volume":"37","author":"Uedono","year":"2024","journal-title":"Am. J. Hypertens."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e162","DOI":"10.1097\/MD.0000000000000162","article-title":"Effect of spironolactone in resistant arterial hypertension: a randomized, double-blind, placebo-controlled trial (ASPIRANT-EXT)","volume":"93","author":"V\u00e1clav\u00edk","year":"2014","journal-title":"Med. Baltim."},{"key":"B29","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1001\/jamacardio.2024.4539","article-title":"Finerenone, serum potassium, and clinical outcomes in heart failure with mildly reduced or preserved ejection fraction","volume":"10","author":"Vardeny","year":"2025","journal-title":"JAMA Cardiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1476029","DOI":"10.3389\/fcvm.2024.1476029","article-title":"A comprehensive review of finerenone-a third-generation non-steroidal mineralocorticoid receptor antagonist","volume":"11","author":"Zhai","year":"2024","journal-title":"Front. Cardiovasc Med."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1918516\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:17:18Z","timestamp":1788949038000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1918516\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":30,"alternative-id":["10.3389\/fphar.2026.1918516"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1918516","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"1918516"}}