Risk of Nephrolithiasis With Finerenone Versus Other Chronic Kidney Disease Medications: A Comparative Real-World Evidence Study
Finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), has shown renoprotective benefits for chronic kidney disease (CKD) in people with type 2 diabetes (T2DM); however, its impact on nephrolithiasis re
Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA) that has demonstrated renoprotective benefits in patients with chronic kidney disease (CKD) and type 2 diabetes. Despite these established advantages, the potential for nephrolithiasis associated with finerenone treatment remains unclear. Understanding this risk is critical for clinicians managing CKD patients who may be at increased susceptibility to urinary stone formation.
Researchers conducted a new-user, active-comparator retrospective cohort study using data from the TriNetX US Collaborative Network spanning June 1, 2021 to June 1, 2024. Adult patients initiating finerenone were compared with 1:1 propensity-score matched cohorts starting spironolactone, SGLT2 inhibitors (SGLT2i), or Angiotensin-Converting enzyme inhibitors/Angiotensin II receptor blockers (ACEi/ARB). The primary outcome measured was nephrolithiasis diagnosis occurring between four and sixteen months after medication initiation.
The study found that finerenone was associated with a significantly higher risk of incident nephrolithiasis compared to spironolactone, SGLT2i, and ACEi/ARB. Hazard ratios indicated a 32.8%, 48.3%, and 49.5% higher relative risk respectively when comparing finerenone to these alternative therapies. This increased risk remained consistent across subgroups including patients with CKD, T2DM, and hypertension.
Among patients with type 2 diabetes already receiving SGLT2i, the addition of finerenone was significantly associated with an increased stone risk compared to SGLT2i monotherapy alone. These findings suggest that while finerenone offers renoprotective benefits, clinicians should consider potential nephrolithiasis risks when prescribing this medication.
This research provides real-world evidence regarding the safety profile of finerenone in CKD management. The authors note that these results are specific to the study population and timeframe. Further investigation is needed to clarify the mechanisms underlying this increased risk and to determine if patient-specific factors influence susceptibility to nephrolithiasis when using finerenone.