Ms Guiqing Xu1, Dr Li Jin1, Dr Huixian Li1, Prof. Wanhong Lu1
1THE FIRST AFFILIATED HOSPITAL OF XI’AN JIAOTONG UNIVERSITY , , China
Biography:
Prof. Wanhong Lu, MD and Chief Physician, is Director of Nephrology at The First Affiliated Hospital of Xi’an Jiaotong University. Her expertise covers immune-related kidney diseases, rare kidney disorders, and integrated CKD management. She leads the Shaanxi Provincial Kidney and Rare Disease Alliance and serves as Vice President of the Shaanxi Physician Association’s Nephrology Branch. She has led multiple grants from the National Natural Science Foundation of China (NSFC). With over 30 SCI/core journal papers and two book chapters.
Abstract:
Background: Malignant hypertension (mHTN) often causes acute kidney injury (AKI) and increases end-stage renal disease risk. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, shows renal protection in diabetic kidney disease, but its effect in mHTN-associated kidney injury is unclear.
Aims: This study aimed to evaluate finerenone’s effect on kidney recovery.
Methods: In this single-center retrospective cohort, patients with mHTN (systolic BP ≥180 mmHg and/or diastolic BP ≥120 mmHg with Keith-Wagener-Barker grade III-IV retinopathy) and concurrent progressive renal dysfunction at the First Affiliated Hospital of Xi’an Jiaotong University were enrolled (January 2019 to December 2024). Based on finerenone use, they were categorized into exposure and control groups. The primary outcome was a composite of kidney recovery: a ≥25% decrease in serum creatinine (Scr), Scr normalization, or dialysis-free survival >1 month. The secondary outcome was a ≥15% increase in estimated glomerular filtration rate (eGFR). Propensity score matching (PSM) at a 1:2 ratio was performed to balance confounders based on age, sex, Scr, proteinuria, and ACEI/ARBs use.
Results: Among 112 patients, 30 received finerenone. After PSM (30 finerenone vs. 46 controls), a higher proportion achieved the primary outcome with finerenone (53.3% vs. 32.9%). Finerenone was independently associated with the primary outcome (adjusted HR: 2.22; 95% CI: 1.12–4.43; p=0.023), remaining significant after PSM (aHR: 2.44; 95% CI: 1.11–5.38; p=0.027). Finerenone was also associated with a ≥15% eGFR increase (aHR: 1.85; 95% CI: 1.02–3.34; p=0.041).
Conclusion: Finerenone treatment was associated with improved kidney recovery and eGFR in mHTN-associated kidney injury, suggesting sustained renal benefits.