INTRODUCTION: The mineralocorticoid receptor antagonists (MRAs) spironolactone 
and eplerenone reduce the risk of hospitalizations and mortality in patients 
with heart failure (HF) with reduced ejection fraction (HFrEF), and attenuate 
progression of diabetic kidney disease. However, their use is limited by the 
fear of inducing hyperkalemia, especially in patients with renal dysfunction. 
Finerenone is a novel nonsteroidal MRA, with higher selectivity toward the 
mineralocorticoid receptor (MR) compared to spironolactone and stronger 
MR-binding affinity than eplerenone.
AREAS COVERED: This paper discusses the chemistry, pharmacokinetics, clinical 
efficacy and safety of finerenone.
EXPERT OPINION: The selectivity and greater binding affinity of finerenone to 
the MR may reduce the risk of hyperkalemia and renal dysfunction and thereby 
overcome the reluctance to start and uptitrate MRAs in patients with HF and 
diabetic kidney disease. Studies conducted in patients with HFrEF and moderate 
chronic kidney disease and diabetic kidney disease, showed promising results. 
Phase III trials will have to show whether finerenone might become the 
third-generation MRA for the treatment of HF and diabetic kidney disease.