Finerenone vertraagt nierfunctieverlies en verlaagt eiwituitscheiding bij niet-diabetische CKD — FIND-CKD & meta-analyse

PURPOSE: Finerenone, a non-steroidal mineralocorticoid receptor antagonist (nsMRA), reduces composite kidney, and cardiovascular endpoints in diabetic CKD. Its efficacy and safety across non-diabetic CKD aetiologies remain uncharacterised in prior meta-analyses. METHODS: Four databases were searched to May 2026. RCTs and observational studies enrolling adults with non-diabetic CKD receiving finerenone were eligible. Two streams were used: Stream A (single-arm) and Stream B (comparative, finerenone vs. controls). The primary outcomes were eGFR slope/12-month change and proteinuria reduction; safety outcomes were hyperkalaemia, hypotension, adverse events, and discontinuation. Random-effects models (Hartung-Knapp), ROB-2, Newcastle-Ottawa Scale, GRADE, and TSA were applied. RESULTS: Nine studies (N = 2020) met eligibility, including two RCTs (the placebo-controlled FIND-CKD trial (n = 1584) and an open-label crossover pilot), alongside seven observational studies. Finerenone significantly slowed eGFR decline in the RCT (slope difference +0.70 mL/min/1.73m2/year, 95%CI 0.30-1.10; P < 0.001) and increased odds of a ≥ 30% proteinuria response roughly four-fold (pooled OR 3.99, 95% CI 1.91-8.30; P = 0.027). Two propensity-matched IgAN cohorts showed a 76.8% reduction in proteinuria versus controls (95% CI -81.1% to -72.6%; I2 = 0%). In single-arm analysis, 28.9% achieved a ≥ 50% proteinuria reduction. Hyperkalaemia was more frequent with finerenone (17.0% vs 13.3%; OR 1.34, 95% CI 1.02-1.76), though any adverse event did not differ (OR 1.15, 95% CI 0.67-1.99); pooled hyperkalaemia was 1.6%, hypotension 0.5%, discontinuation 0/258. CONCLUSIONS: In non-diabetic CKD, finerenone slows eGFR decline, supported by high-certainty evidence from FIND-CKD, and reduces proteinuria, with a modest rise in hyperkalaemia. These data support finerenone as a kidney-protective, proteinuria-lowering therapy, underscoring the need for potassium monitoring, and further trials.