Finerenone's Promise in Heart Failure and Kidney Disease.
Document Type
Article
Publication Date
5-27-2025
Publication Title
Cardiology in review
Abstract
The mineralocorticoid receptor (MR) plays a pivotal role in cardiorenal disease progression, but steroidal MR antagonists (MRAs) are limited by hyperkalemia, hormonal side effects, and uncertain efficacy in heart failure with preserved ejection fraction (HFpEF). Finerenone, a first-in-class nonsteroidal MRA, offers selective MR blockade with balanced tissue distribution, mitigating off-target effects while demonstrating cardiorenal benefits. Phase 3 trials (FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF) show significant reductions in renal (18-21%) and cardiovascular (13-16%) composite endpoints, including HFpEF, where it reduced worsening heart failure events by 16%. Unlike steroidal MRAs, finerenone reduces off-target effects while maintaining efficacy in HFpEF, a population with limited therapeutic options. This review synthesizes finerenone's pharmacological innovations, clinical evidence, and practical challenges, highlighting its potential as a transformative therapy in cardiorenal disease.
Recommended Citation
Shokri K, Mohammadi A, Karimian A, Adeel MY, Mozaffari MA, Frishman WH et al Finerenone's promise in heart failure and kidney disease. Cardiol Rev. 2025 May 27. doi: 10.1097/CRD.0000000000000958. Epub ahead of print. PMID: 40423595.
DOI
10.1097/CRD.0000000000000958
ISSN
1538-4683
PubMed ID
40423595