FINERENONE was associated with a significantly higher risk of incident nephrolithiasis than spironolactone, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, according to a comparative real-world evidence study. The findings suggest that nephrolithiasis may warrant consideration when assessing treatment with finerenone in patients with chronic kidney disease (CKD).
The retrospective cohort study used data from the TriNetX US Collaborative Network covering June 2021 to June 2024. Researchers included adult patients initiating finerenone and compared them with propensity-score matched cohorts starting spironolactone, SGLT2i, or angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB). The primary outcome was a new diagnosis of nephrolithiasis occurring 4 to 16 months after treatment initiation.
After matching, finerenone was associated with a higher incidence of nephrolithiasis across all three comparator groups. Compared with spironolactone, the hazard ratio (HR) was: 1.328; 95% confidence interval (CI): 1.065 t0 1.657. Compared with SGLT2i, the HR was: 1.483; 95% CI: 1.118 to 1.967. Against ACEi/ARB, the HR was: 1.495; 95% CI: 1.145 to 1.953.
These findings corresponded to relative increases in nephrolithiasis risk of 32.8%, 48.3%, and 49.5%, respectively. The association remained consistent across subgroups that included patients with CKD, type 2 diabetes mellitus, and hypertension.
The data also highlighted a potential interaction with SGLT2i therapy. Among patients with type 2 diabetes mellitus who were already receiving an SGLT2i, adding finerenone was significantly associated with greater stone risk than SGLT2i monotherapy.
The authors concluded that finerenone was associated with a higher incidence of new-onset nephrolithiasis and suggested that it may influence the potential stone-protective effects of SGLT2i. For clinicians, these findings provide comparative real-world evidence that may inform consideration of nephrolithiasis risk when finerenone is used alongside other CKD pharmacological therapies.
Chen YH et al. Risk of nephrolithiasis with finerenone versus other chronic kidney disease medications: a comparative real-world evidence study. Sci Rep. 2026;DOI:1038/s41598-026-65475-8.
Featured Image: mintra on Adobe Stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
