Finerenone slows kidney decline in non-diabetic CKD

Clinical Takeaway: Patients with chronic kidney disease without diabetes remain at substantial risk for progressive kidney function loss despite current standard therapies. Finerenone may offer an additional option to slow CKD progression and reduce cardiorenal complications across a broad range of non-diabetic kidney diseases.

Chronic kidney disease (CKD) affects hundreds of millions of people worldwide, and many patients develop progressive kidney dysfunction despite not having diabetes. While renin-angiotensin system blockade remains a cornerstone of treatment, additional therapies capable of preserving kidney function have been limited for this population.

Importantly, previous large finerenone trials focused primarily on patients with type 2 diabetes. FIND-CKD, the largest phase 3 trial conducted to date in non-diabetic chronic kidney disease, evaluated a broad population of patients with non-diabetic CKD, including those with hypertension-associated kidney disease and glomerular diseases.

The trial enrolled 1,584 adults with non-diabetic CKD who had reduced kidney function and elevated urinary protein excretion despite standard treatment with an ACE inhibitor or angiotensin receptor blocker.

Finerenone significantly slowed kidney function decline compared with placebo. The annual rate of decline in estimated glomerular filtration rate (eGFR) was reduced by 0.7 mL/min/1.73 m² per year (95% confidence interval, 0.3-1.1; P<0.001).

The treatment also reduced the risk of a composite cardiovascular-kidney outcome by 23% (hazard ratio, 0.77; 95% confidence interval, 0.60-0.99; P=0.043). This composite endpoint included kidney failure, sustained loss of kidney function, hospitalization for heart failure, or cardiovascular death.

Markers of kidney injury also improved. Proteinuria decreased by more than 41% with finerenone versus approximately 9% with placebo, and more than half of finerenone-treated patients achieved at least a 30% reduction in urinary protein excretion.

Finerenone was generally well tolerated, with no new safety signals identified. Hyperkalemia-related adverse events occurred more frequently with finerenone than placebo, although few events resulted in treatment discontinuation or hospitalization. Rates of acute kidney injury were similar between groups.

An exploratory subgroup analysis of FIND-CKD, presented separately at the ERA Congress and published in JAMA, found similar benefits among patients with glomerular diseases, including slower kidney function decline, lower albuminuria, and reduced risk of kidney failure or substantial loss of kidney function. These findings suggest that finerenone's benefits may extend across multiple non-diabetic CKD etiologies.

Bayer has stated that it plans to submit the FIND-CKD data to regulatory authorities, including FDA, to seek an expanded indication for Kerendia (finerenone) in non-diabetic chronic kidney disease.

“Finerenone could become an important new treatment option for people with chronic kidney disease who do not have diabetes. The drug offers a clear delay in the decline of kidney function on top of current standard care. The results provide physicians with new therapeutic options to help preserve kidney function and reduce the number of cardiovascular and renal complications. And this applies to a broad, underserved patient population with non-diabetic CKD, for whom there are few treatment options in the guidelines,” said Hiddo Lambers Heerspink, PhD, professor of Clinical Trials and Personalized Medicine at the University Medical Center Groningen and lead investigator of the FIND-CKD trial.

Sources:

Heerspink HJL, et al. New Engl J Med. 2026 June 4. Finerenone in Persons with Chronic Kidney Disease without Diabetes

Neuen BL, et al. JAMA. 2026 June 5. Finerenone in patients with chronic kidney disease due to glomerular diseases