{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:39:23Z","timestamp":1792291163382,"version":"4.4.0"},"reference-count":40,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Finerenone has emerged as a promising nonsteroidal mineralocorticoid receptor antagonist for patients with chronic kidney disease (CKD), yet its safety and efficacy in kidney transplant recipients remain unstudied. Methods: A total of 1750 kidney transplant recipients were screened, and 39 were prescribed finerenone alongside angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Fifteen patients who met inclusion criteria and used finerenone consistently for at least six months were compared with 15 matched controls. Proteinuria, renal function, serum potassium, and other laboratory and clinical parameters were assessed at baseline and at 1, 3, and 6 months. Results: Finerenone was discontinued in two patients (5.1%) due to flushing and headache. Severe hyperkalemia occurred in four patients (10.2%). In the finerenone group, proteinuria significantly decreased at all time points (p &lt; 0.05), with a 40% reduction at six months. No significant changes in estimated glomerular filtration rate or serum creatinine were observed. Conclusions: Finerenone is a promising adjunct therapy in kidney transplant patients for reducing proteinuria without impairing renal function for those patients who can tolerate it. However, in the early phase of treatment initiation, patients should be closely monitored for adverse effects including hyperkalemia.<\/jats:p>","DOI":"10.3390\/jcm14238296","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:31:54Z","timestamp":1764088314000},"page":"8296","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Efficacy and Safety of Finerenone in Kidney Transplant Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Serdar","family":"Kahvecioglu","sequence":"first","affiliation":[{"name":"Nephrology Department, Bursa Y\u00fcksek \u0130htisas Trainig and Research Hospital, Bursa 16310, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huseyin","family":"Celik","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bursa Ac\u0131badem Hospital, Bursa 16210, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2468-351X","authenticated-orcid":false,"given":"Asena Serap","family":"Yalcinkaya","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bursa Y\u00fcksek \u0130htisas Trainig and Research Hospital, Bursa 16310, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4607-9220","authenticated-orcid":false,"given":"Yavuz","family":"Ayar","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bursa Y\u00fcksek \u0130htisas Trainig and Research Hospital, Bursa 16310, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimet","family":"Aktas","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bursa Y\u00fcksek \u0130htisas Trainig and Research Hospital, Bursa 16310, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1575-2649","authenticated-orcid":false,"given":"Ozger","family":"Akarsu","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bursa Y\u00fcksek \u0130htisas Trainig and Research Hospital, Bursa 16310, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e068769","DOI":"10.1136\/bmj-2021-068769","article-title":"Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: Systematic review and meta-analysis","volume":"376","author":"Chaudhry","year":"2002","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Minkovich, M., Gupta, N., Liu, M., Famure, O., Li, Y., Selzner, M., Lee, J.Y., Kim, S.J., and Ghanekar, A. (2024). Impact of early surgical complications on kidney transplant outcomes. BMC Surg., 24.","DOI":"10.1186\/s12893-024-02463-7"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2024). 11. Chronic kidney disease and risk management: Standards of care in diabetes\u20132024. Diabetes Care, 47, S219\u2013S230.","DOI":"10.2337\/dc24-S011"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.2337\/dci22-0027","article-title":"Diabetes management in chronic kidney disease: A consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"45","author":"Khunti","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","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":"ref_6","doi-asserted-by":"crossref","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":"ref_7","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s40620-019-00681-4","article-title":"Impact of mineralocorticoid receptor antagonist in renal transplant patients: A systematic review and meta-analysis of randomized controlled trials","volume":"33","author":"Abdelhakim","year":"2020","journal-title":"J. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.transproceed.2017.01.075","article-title":"Spironolactone in post-transplant proteinuria: A safe alternative therapy","volume":"49","author":"Guida","year":"2017","journal-title":"Transplant. Proc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e14557","DOI":"10.1111\/petr.14557","article-title":"Long-term effect of eplerenone treatment in children with chronic allograft nephropathy","volume":"27","author":"Baskin","year":"2023","journal-title":"Pediatr. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"F1072","DOI":"10.1152\/ajprenal.90643.2008","article-title":"Spironolactone ameliorates transplant vasculopathy in renal chronic transplant dysfunction in rats","volume":"296","author":"Waanders","year":"2009","journal-title":"Am. J. Physiol. Renal Physiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s11255-024-04256-6","article-title":"Mineralocorticoid receptor blockage in kidney transplantation: Too much of a good thing or not?","volume":"57","author":"Afsar","year":"2025","journal-title":"Int. Urol. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1093\/ajh\/hpy120","article-title":"Roles of mineralocorticoid receptors in cardiovascular and cardiorenal diseases","volume":"31","author":"Buonafine","year":"2018","journal-title":"Am. J. Hypertens."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kolkhof, P., Lawatscheck, R., Filippatos, G., and Bakris, G.L. (2022). Nonsteroidal mineralocorticoid receptor antagonism by finerenone-translational aspects and clinical perspectives across multiple organ systems. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23169243"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"105859","DOI":"10.1016\/j.phrs.2021.105859","article-title":"Nonsteroidal mineralocorticoid receptor antagonism for cardiovascular and renal disorders\u2014New perspectives for combination therapy","volume":"172","author":"Kolkhof","year":"2021","journal-title":"Pharmacol. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s41581-021-00490-8","article-title":"Mineralocorticoid receptor antagonists in diabetic kidney disease\u2014Mechanistic and therapeutic effects","volume":"18","author":"Bakris","year":"2022","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1161\/HYPERTENSIONAHA.121.17073","article-title":"Effect of KBP-5074 on blood pressure in advanced chronic kidney disease: Results of the BLOCK-CKD study","volume":"78","author":"Bakris","year":"2021","journal-title":"Hypertension"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"i29","DOI":"10.1093\/ndt\/gfae241","article-title":"Mineralocorticoid receptor antagonism for non-diabetic kidney disease","volume":"40","author":"Jaisser","year":"2025","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1001\/jama.2010.39","article-title":"Relation between kidney function, proteinuria, and adverse outcomes","volume":"303","author":"Hemmelgarn","year":"2010","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1097\/00007890-200204270-00028","article-title":"The risk of cardiovascular disease associated with proteinuria in renal transplant patients","volume":"73","author":"Escallada","year":"2002","journal-title":"Transplantation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.2215\/CJN.01310211","article-title":"Posttransplantation proteinuria: An approach to diagnosis and management","volume":"6","author":"Shamseddin","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1056\/NEJMoa2410659","article-title":"Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes","volume":"393","author":"Agarwal","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Currie, G., Taylor, A.H.M., Fujita, T., Ohtsu, H., Lindhardt, M., Rossing, P., Boesby, L., Edwards, N.C., Ferro, C.J., and Townend, J.N. (2016). Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: A systematic review and meta-analysis. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0337-0"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1007\/s40620-024-02070-y","article-title":"First interim results from FINE-REAL: A prospective, non-interventional, phase 4 study providing insights into the use and safety of finerenone in a routine clinical setting","volume":"7","author":"Nicholas","year":"2024","journal-title":"J. Nephrol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/j.jchf.2022.06.010","article-title":"Steroidal MRA Across the Spectrum of Renal Function: A Pooled Analysis of RCTs","volume":"10","author":"Ferreira","year":"2022","journal-title":"JACC Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.ahj.2015.01.014","article-title":"Clinical Benefit of Spironolactone in Patients with Acute Decompensated Heart Failure and Severe Renal Dysfunction: Data from the Korean Heart Failure Registry","volume":"169","author":"Oh","year":"2015","journal-title":"Am. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.ijcard.2017.03.080","article-title":"Effect of Spironolactone on the Risks of Mortality and Hospitalization for Heart Failure in Pre-Dialysis Advanced Chronic kidney Disease: A Nationwide Population-Based Study","volume":"238","author":"Tseng","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.amjcard.2014.03.062","article-title":"Spironolactone Use and Higher Hospital Readmission for Medicare Beneficiaries with Heart Failure, LeftVentricular Ejection Fraction <45%, and Estimated Glomerular Filtration Rate <45 ml\/min\/1.73 m2. Am","volume":"114","author":"Inampudi","year":"2014","journal-title":"J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"755","DOI":"10.2215\/CJN.0000000000000439","article-title":"Effect of Spironolactone on Kidney Function in Kidney Transplant Recipients (the SPIREN trial): A Randomized Placebo-Controlled Clinical Trial","volume":"19","author":"Mortensen","year":"2024","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1093\/eurheartj\/ehy100","article-title":"Serum potassium and adverse outcomes across the range of kidney function: A CKD prognosis consortium meta-analysis","volume":"39","author":"Kovesdy","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_31","unstructured":"Clase, C.M., Carrero, J.-J., Ellison, D.H., Grams, M.E., Hemmelgarn, B.R., Jardine, M.J., Kovesdy, C.P., Kline, G.A., Lindner, G., and Obrador, G.T. (2021, December 09). Potassium homeostasis and management of dyskalemia in kidney diseases: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Available online: https:\/\/kdigo.org\/wp-content\/uploads\/2018\/04\/KDIGO-Potassium-Management-Final-publication.pdf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"940","DOI":"10.2215\/CJN.00240106","article-title":"Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes","volume":"1","author":"Epstein","year":"2006","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1093\/eurheartj\/eht187","article-title":"Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: A randomized, double-blind trial","volume":"34","author":"Pitt","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","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":"ref_35","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1056\/NEJMoa1313731","article-title":"Spironolactone for heart failure with preserved ejection fraction","volume":"370","author":"Pitt","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"108411","DOI":"10.1016\/j.jdiacomp.2023.108411","article-title":"Design and rationale of FINE-REAL: A prospective study of finerenone in clinical practice","volume":"37","author":"Desai","year":"2023","journal-title":"J. Diabetes Complicat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1097\/TP.0000000000001243","article-title":"Calcineurin inhibitor nephrotoxicity through the lens of longitudinal histology: Comparison of cyclosporine and tacrolimus eras","volume":"100","author":"Nankivell","year":"2016","journal-title":"Transplantation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1046\/j.1523-1755.2003.00707.x","article-title":"Therapeutic benefit of spironolactone in experimental chronic cyclosporine a nephrotoxicity","volume":"63","author":"Feria","year":"2003","journal-title":"Kidney Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e14206","DOI":"10.1111\/eci.14206","article-title":"Mineralocorticoid receptor antagonists in kidney transplantation","volume":"54","author":"Kanbay","year":"2024","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Figueroa, S.M., Bertocchio, J.-P., Nakamura, T., El-Moghrabi, S., Jaisser, F., and Amador, C.A. (2023). The Mineralocorticoid Receptor on Smooth Muscle Cells Promotes Tacrolimus-Induced Renal Injury in Mice. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15051373"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8296\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:44:47Z","timestamp":1764089087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,22]]},"references-count":40,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238296"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238296","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,22]]}}}