Pharmaceutical antagonism of the mineralocorticoid receptor (MR) can protect 
against organ damage caused by elevated aldosterone levels in patients 
experiencing heart failure (HF), chronic kidney disease (CKD), primary 
aldosteronism, and hypertension. While traditional steroid-based MR antagonists 
effectively reduce mortality rates and extend patient survival, their broad 
application has been limited by significant side effects, most notably 
hyperkalaemia. Recently, finerenone (BAY 94-8862) has emerged as a 
next-generation non-steroidal dihydropyridine-based MR antagonist designed to 
minimize off-target effects while maintaining potent efficacy. In this review, 
the outcomes of finerenone therapy in several diseases associated with MR 
activity are explored. The (pre-) clinical efficacy of finerenone is compared 
with that of traditional steroid-based MR antagonists. Finally, recent and 
ongoing clinical trials using finerenone to treat chronic HF, CKD, and diabetic 
nephropathy are discussed. Taken together, pre-clinical and clinical evidence 
suggests that finerenone may achieve equivalent organ-protective effects with 
reduced levels of electrolyte disturbance compared with traditional 
steroid-based MR antagonists. This supports further clinical development of 
finerenone for the treatment of cardiovascular and renal disease.