Treatment with the nonsteroidal mineralocorticoid receptor antagonist finerenone appears to slow kidney function decline in nondiabetic patients with chronic kidney disease (CKD) who are on renin–angiotensin system (RAS) inhibitors, according to the phase III FIND-CKD trial.
From baseline to month 32, the mean annual rate of change in the estimated glomerular filtration rate (eGFR) was −3.3 mL/min/1.73 m² with finerenone vs −4 mL/min/1.73 m² with placebo (difference, 0.7, 95 percent confidence interval [CI], 0.3–1.1; p<0.001), reported principal investigator Dr Hiddo Heerspink from the University of New South Wales, Sydney, Australia, and colleagues. [N Engl J Med 2026;395:533-545]
Additionally, the incidence rate of the composite of kidney or cardiovascular events was lower with finerenone than with placebo, at 4.7 vs 5.8 events per 100 person-years (hazard ratio [HR], 0.77, 95 percent CI, 0.60–0.99; p=0.04).
Results for the composite of a sustained decrease from baseline of ≥57 percent in the eGFR or kidney failure also favoured finerenone over placebo (HR, 0.78, 95 percent CI, 0.60–1.01; p=0.06), as did the those for the composite of hospitalization for heart failure or death from cardiovascular causes (HR, 0.60, 95 percent CI, 0.27–1.33). However, the differences did not reach significance.
“No unanticipated safety signals were observed with finerenone in the current trial,” noted Heerspink and colleagues. “Hyperkalaemia was the most common adverse event, but increases in the serum potassium level were modest.”
Hyperkalaemia occurred in 17 percent of patients in the finerenone group vs 13.3 percent of those in the placebo group. From baseline to month 1, the mean serum potassium level was higher by 0.12 mmol/l with finerenone vs placebo, with levels in finerenone-treated patients stabilizing thereafter. Hyperkalaemia led to hospitalization in 0.9 percent of patients in the finerenone group and 0.6 percent in the placebo group and to permanent treatment discontinuation in 1.5 percent vs 0.1 percent, respectively. No fatal hyperkalaemia events occurred.
“The incidence rates of acute kidney injury and symptomatic hypotension were also low and similar in the finerenone and placebo groups,” Heerspink and colleagues said.
The effect of finerenone on preserving kidney function has already been demonstrated in people with CKD and type 2 diabetes. The mean annual rate of change in eGFR observed with finerenone vs placebo in FIND-CKD was consistent with that seen in the FIDELIO-DKD trial and similar to that reported with other kidney-protective drugs, including RAS inhibitors and sodium–glucose cotransporter 2 (SGLT2) inhibitors. [N Engl J Med 2020;383:2219-29; N Engl J Med 2021;385:2252-63; Eur Heart J 2022;43:474-84; Lancet Diabetes Endocrinol 2021;9:743-54; Lancet Diabetes Endocrinol 2024;12:39-50; Lancet Diabetes Endocrinol 2024;12:51-60]
In FIND-CKD, 17 percent of patients were using SGLT2 inhibitors at baseline, and the efficacy of finerenone in this group of patients was similar to that in patients who were not using SGLT2 inhibitors, Heerspink and colleagues noted.
“Although we hypothesize that the use of both finerenone and SGLT2 inhibitors may provide complementary effects, this was not directly tested in the present trial,” they said.
Potential new treatment
“This new trial provides important and needed data for patients and healthcare providers. In patients who have CKD without diabetes but with albuminuria, finerenone represents a potential new treatment,” wrote Dr Robert Toto from the University of Texas Southwestern Medical Center, Dallas, Texas, US, in an accompanying editorial. [N Engl J Med 2026;395:600-601]
“The results indicate that the addition of finerenone to a RAS inhibitor, with or without an SGLT2 inhibitor, may provide additional kidney and cardiovascular benefits,” Toto added.
FIND-CKD, along with the FIDELIO-DKD and FIGARO-DKD trials, highlights the potential of finerenone as a foundational therapy in many patients who have CKD and albuminuria with or without diabetes, he concluded.
FIND-CKD involved 1,584 diabetes-free patients (mean age 54.7 years, 66.2 percent male, 54.8 percent Asian) with CKD. Of these, 99.7 percent were receiving a RAS inhibitor. The median urinary albumin-to-creatinine ratio was 818.9.
The patients were randomly assigned to treatment with finerenone at 10 or 20 mg daily (n=793) or placebo (n=791). Baseline characteristics and concomitant medications were balanced between the two groups. The mean eGFR decreased from 46.8 mL/min/1.73 m² at baseline to 39.4 mL/min/1.73 m² at month 32 with finerenone and from 46.6 to 38.1 mL/min/1.73 m², respectively, with placebo.