Finerenone for Chronic Kidney Disease: New Evidence Suggests Benefits Beyond Diabetes

A series of major clinical studies presented at the congress of the European Renal Association in Glasgow and simultaneously published in The Lancet, The New England Journal of Medicine, and JAMA has shown that finerenone can slow the progression of chronic kidney disease (CKD), reduce cardiovascular risks, and improve survival in a much broader patient population than is currently reflected in clinical guidelines.

Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that is currently approved for the treatment of CKD associated with type 2 diabetes. However, activation of the mineralocorticoid pathway plays a key role in the development of inflammation and fibrosis across various forms of kidney disease, providing a rationale for investigating the drug in patients without diabetes.

The FIND-CKD trial enrolled 1,584 patients from 24 countries with non-diabetic CKD. The addition of finerenone to standard therapy significantly slowed the decline in kidney function. The drug also reduced the combined risk of kidney failure, CKD progression, heart failure, or cardiovascular death by 23%.

A separate analysis published in JAMA focused on patients with glomerular diseases—immune-mediated kidney disorders for which treatment options remain limited. In this group, finerenone reduced the risk of CKD progression or kidney failure by 26% and lowered albuminuria by 42% after 12 months, indicating a reduction in damage to the kidney’s filtering units.

A third integrative analysis published in The Lancet combined data from FIND-CKD with two previous Phase III clinical trials involving patients with both diabetic and non-diabetic CKD, for a total of 14,574 participants. Across the pooled population, finerenone reduced the risk of kidney failure progression or substantial deterioration in kidney function by 24%, lowered the risk of hospitalization for heart failure or cardiovascular death by 20%, and reduced all-cause mortality by 12%.

Importantly, these benefits were observed regardless of diabetes status, the underlying type of kidney disease, or baseline kidney function.

Overall, finerenone demonstrated a favorable safety profile. The main adverse effect was hyperkalemia—elevated potassium levels in the blood—which occurred more frequently than in the placebo group. However, severe cases requiring treatment discontinuation or hospitalization were uncommon.

Chronic kidney disease affects approximately 10% of the global population and is already among the leading causes of death and disability worldwide, with its burden expected to increase further in the coming decades. Against this backdrop, expanding therapeutic options is considered a critical priority in nephrology.

According to the researchers, the combined evidence suggests that finerenone has the potential to become a foundational therapy for CKD regardless of diabetes status, offering substantial protection against kidney failure and cardiovascular complications for millions of patients.

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