Finerenone shows broader potential in CKD

By Sasha Ellery BA, BM BCh

Finerenone slows kidney function decline in adults with albumi­nu­­ric chronic kidney disease (CKD) without diabetes, new research shows, with supporting analyses suggesting benefits across glomerular disease subtypes and the broader CKD spectrum.

In the phase 3 FIND-CKD trial, published in The New England Journal of Medicine, 1584 adults without diabetes who had CKD and albuminuria were randomly assigned to finerenone or placebo, in addition to renin–angiotensin system inhibition. Over 32 months, the annual rate of estimated glomerular filtration rate (eGFR) decline was slower with finerenone than with placebo. The risk of a composite kidney or cardiovascular outcome was also lower with finerenone. Hyperkalaemia was more common with finerenone, but discontinuation and hospitalisation rates were low.

Professor Carol Pollock, Professor of Medicine at the Northern Clinical School, The University of Sydney, and Chair of Kidney Health Australia, said the absolute difference in eGFR decline was clinically meaningful despite appearing modest.

‘On average, [finerenone] slowed the rate of decline in eGFR by 0.7 mL/min/1.73 m² each year,’ she said. ‘It doesn’t sound much, but in this high-risk population with CKD and significant albuminuria, treatment with finerenone over a 10-year period would “accrue” an additional GFR of 7 mL/min/1.73 m². This equates to dialysis being deferred for more than two years compared with patients not receiving finerenone.’

A prespecified exploratory analysis in JAMA focused on 903 FIND-CKD participants with investigator-reported glomerular disease, including immunoglobulin A nephropathy, focal segmen­tal glomerulosclerosis and membranous nephropathy. Finerenone slowed eGFR decline, reduced albuminuria by 42% at 12 months and lowered the risk of kidney failure or at least 40% eGFR decline compared with placebo. The authors noted that effects were broadly consistent across glomerular disease subtypes, although the analysis was exploratory and not powered for each subtype.

The INFINITY pooled individual participant data analysis, published in The Lancet, combined three finerenone trials: FIDELIO-DKD, FIGARO-DKD and FIND-CKD. Across 14,574 participants followed for a median of 3.1 years, finerenone reduced the risk of CKD progression (including kidney failure) and reduced hospitalisation for heart failure, cardiovascular death and all-cause death. Effects were reported as broadly consistent by glycaemic status, CKD aetiology, baseline eGFR, albuminuria and sodium–glucose co-transporter 2 inhibitor use.

Professor Pollock told Medicine Today that the findings supported consideration of finerenone in patients with proteinuric CKD more broadly, while acknowledging that current Australian access remained narrower.

‘Patients with proteinuria irrespective of the cause of CKD should be considered for treatment with finerenone, given established cardiovascular and renal protection,’ she said.

‘Finerenone is currently indicated for patients with type 2 diabetes and CKD (eGFR >25 mL/min/1.73 m²) who, despite blockade of the renin–angiotensin system and sodium–glucose co-transporter 2 inhibition, if tolerated, have ongoing albuminuria (>22.6 mg/mmol creatinine),’ Professor Pollock explained. ‘Although clinical trials have shown benefit in patients with heart failure and preserved ejection fraction and in albuminuric patients with type 1 diabetes, it is not currently on the PBS for these indications.’

N Engl J Med 2026; doi: 10.1056/NEJMoa2604625, JAMA 2026; doi: 10.1001/jama.2026.9923 and Lancet 2026; 407: 2375-2386.