Objective: To explore the efficacy of finerenone on patients with diabetic nephropathy (DN) and the risk factors for renal function progression. Methods: The clinical data of 100 DN patients treated with finerenone were retrospectively analyzed. All DN patients were evaluated for estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio (UACR) after completion of the established course of treatment. If eGFR was decreased by less than 15% compared to baseline and uACR was decreased by ≥30%, the patients were classified as effective group (n=75), otherwise the patients were assigned as ineffective group (n=25). The differences in general data and treatment conditions between the two groups of DN patients were compared, and the risk factors affecting renal function progression were analyzed by multivariate Logistic regression analysis. Results: After treatment, both groups of DN patients showed significantly reduced eGFR and UACR levels compared to pre-treatment levels (P<0.05). eGFR levels in ineffective group before and after treatment were significantly lower while UACR levels were significantly higher than those in effective rate group (P<0.05). Duration of diabetes, duration of DN, history of hypertension, baseline eGFR, Scr, BUN, baseline UACR, FPG, HbA1c, 2hPG, TC, TG, LDL-C and HDL-C were single factors factors influencing renal function progression in DN patients (P<0.05). Logistic regression analysis revealed that duration of DN, history of hypertension, baseline UACR, HbA1c and LDL-C were risk factors for renal function progression in DN patients, while baseline eGFR was a protective factor. Conclusion: The duration of DN, history of hypertension, baseline eGFR, baseline UACR, HbA1c and LDL-C can independently influence the progression of renal function in patients with DN. Clinically, based on the above factors, the management regimen of DN patients can be formulated and optimized in a predictive manner to improve the prognosis of patients.