Large international studies have found that the kidney disease drug finerenone may benefit far more patients than current treatment guidelines recommend.
Researchers reported that the medication helps protect kidney function, lowers the risk of cardiovascular complications, and improves survival in people with chronic kidney disease (CKD). The benefits were seen not only in patients with diabetes but also in those with non-diabetic CKD and certain forms of glomerular disease.
The findings were presented at the European Renal Association Congress in Glasgow, United Kingdom, and were simultaneously published in three leading medical journals: The Lancet, The New England Journal of Medicine, and JAMA. Achieving publication in all three journals at the same time is an uncommon milestone in clinical research.
Finerenone Shows Promise Beyond Diabetes
Finerenone is a non-steroidal mineralocorticoid receptor antagonist currently approved to treat CKD associated with type 2 diabetes. Researchers have become increasingly interested in whether the drug could help a broader range of kidney disease patients because excessive activation of the mineralocorticoid receptor contributes to inflammation and scarring in many kidney disorders.
To investigate this possibility, scientists from The George Institute for Global Health launched a series of studies examining finerenone in populations beyond those covered by its current approval.
FIND-CKD Trial Slowed Kidney Function Decline
The FIND-CKD trial, led by Professor Hiddo Heerspink of The George Institute and Professor Vlado Perkovic of UNSW Sydney, enrolled 1,584 people with non-diabetic CKD across 24 countries.
Patients who received finerenone in addition to standard treatment experienced a significantly slower decline in kidney function compared with those receiving standard care alone. The study also found that finerenone reduced the combined risk of kidney failure, worsening CKD, heart failure, or cardiovascular death by 23%.
Results from the FIND-CKD trial were published in The New England Journal of Medicine.
Benefits Seen in Glomerular Diseases
A second analysis, led by Associate Professor Brendon Neuen of The George Institute and published in JAMA, focused on participants with glomerular diseases. These conditions involve immune-related damage to the kidney’s filtering units and often have limited treatment options.
Among these patients, finerenone lowered the risk of kidney failure or CKD progression by 26% compared with placebo. The drug also reduced albuminuria, a measure of protein in the urine and an important sign of kidney damage, by 42% after 12 months.
Reduced Kidney Failure, Heart Risk, and Death
In a third study published in The Lancet, researchers combined data from the FIND-CKD trial with two earlier phase III studies involving patients with diabetic CKD.
The pooled analysis included 14,574 participants with both diabetic and non-diabetic chronic kidney disease. Compared with placebo, finerenone reduced the risk of kidney failure or disease progression by 24%.
The drug also lowered the risk of hospitalization for heart failure or cardiovascular death by 20% and reduced the risk of death from any cause by 12%.
Researchers reported that these benefits remained consistent regardless of whether patients had diabetes, what type of kidney disease they had, or their level of kidney function.
Associate Professor Brendon Neuen, Lead Global Clinical Trialist at The George Institute, said the findings support finerenone as a foundational therapy for CKD.
“Although diabetes is the single most common cause of chronic kidney disease worldwide, most people living with CKD do not have diabetes and currently have few effective treatment options. Addressing this unmet need is critical, as improving outcomes in non-diabetic CKD has the potential to substantially reduce the global burden of kidney disease.”
Potential Impact on Millions of People
Across all three studies, finerenone was generally well tolerated. Elevated blood potassium levels (hyperkalaemia) occurred more often among patients taking the drug than among those receiving placebo. However, treatment discontinuation and hospitalizations related to hyperkalaemia were uncommon.
Chronic kidney disease affects roughly one in ten people worldwide, representing about 850 million individuals. Already a major cause of illness and death, CKD is projected to become the fifth leading cause of premature death globally by 2040.
As the disease advances, the risks of hospitalization, cardiovascular complications, and death rise sharply, making early and effective treatment increasingly important.
A/Prof Neuen said, “Taken together, these findings suggest that expanding the use of finerenone in patients with CKD has the potential to meaningfully reduce kidney failure and cardiovascular complications for millions of people worldwide.”