Abstract: FR-PO0412
Effect of Finerenone on Kidney Outcomes in Malignant Hypertension-Associated Kidney Injury: A Propensity Score-Matched Retrospective Cohort Study
Session Information
- AKI: Biomarkers, Diagnostics, and Risk Prediction
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Xu, Guiqing, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Li, Huixian, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Jin, Li, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Lu, Wanhong, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Background
Malignant hypertension (mHTN) often causes acute kidney injury (AKI) and increases ESRD risk. Current antihypertensives control blood pressure but provide limited renal protection. Finerenone, a nonsteroidal MRA, has renal benefit in diabetic kidney disease, yet its efficacy in mHTN-associated kidney injury is unknown. This study evaluated finerenone’s effect on kidney recovery in this population using real-world data.
Methods
This single-center retrospective cohort study enrolled patients with mHTN and progressive renal dysfunction at the First Affiliated Hospital of Xi’an Jiaotong University (2014-2024). Exclusion criteria: incomplete baseline data or follow-up <3 months. Patients were followed until endpoint, death, loss, or 12 months. Based on finerenone use, participants were assigned to exposure or control group. Primary outcome: composite of kidney recovery (≥25% Scr decrease, Scr normalization, or dialysis-free ≥1 month). Secondary outcome: ≥15% eGFR increase. Propensity score matching (1:2) was performed for age, sex, baseline Scr, 24h proteinuria, and ACEI/ARB use. Cox regression assessed renal prognosis factors.
Results
Of 112 patients, 30 (26.8%) received finerenone and 82 (73.2%) did not. After 1:2 PSM, the finerenone group (n=30) and control group (n=46) had balanced covariates. Finerenone-treated patients showed lower serum creatinine, 24-hour proteinuria, and potassium, as well as higher eGFR, complement C3, and ACEI/ARB use.Primary outcome (kidney recovery composite) was achieved in 53.3% of the finerenone group compared with 32.9% of the control group. Multivariable Cox regression showed that finerenone treatment was independently associated with the primary outcome (adjusted HR 2.22; 95% CI 1.12-4.43; p=0.023), and this association remained significant after PSM (adjusted HR 2.44; 95% CI 1.11-5.38; p=0.027).Secondary outcome (≥15% increase in eGFR) was also independently associated with finerenone treatment (adjusted HR 1.85; 95% CI 1.02-3.34; p=0.041), and the association persisted after PSM (adjusted HR 1.93; 95% CI 1.01-3.69; p=0.045).
Conclusion
In this cohort, finerenone treatment was associated with improved kidney recovery and eGFR increase inpatients with mHTN associated kidney injury, suggesting potential renal benefits. These findings warrant validation in prospective studies.