Finerenone is a treatment option in non-diabetic kidney disease

Compared with placebo, finerenone slowed the decline of the annualised estimated glomerular filtration rate (eGFR) while increasing rates of hyperkalaemia in patients with non-diabetic chronic kidney disease (CKD), according to results reported by Prof. David Cherney (University of Toronto, Canada) and Prof. Hiddo J.L. Heerspink (University of Groningen, the Netherlands) [1].

FIND-CKD (NCT05047263) is a phase 3, randomised, double-blind, placebo-controlled trial assessing the effect of finerenone in patients with non-diabetic CKD. Patients were eligible if they were at risk of disease progression despite optimised angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy and were randomised 1:1 to receive either finerenone 10 mg once daily (eGFR ≥25 to <60 mL/min/1.73 m²), finerenone 20 mg once daily (eGFR ≥60 mL/min/1.73 m²), or placebo for a total treatment duration of 36 months. The primary endpoint was the mean annual rate of change in eGFR assessed as the total eGFR slope from baseline to month 32. Overall, 793 patients were included in the finerenone group and 791 in the placebo group.

Compared with placebo, finerenone significantly slowed eGFR decline, as demonstrated by the eGFR slope analysis. Subgroup analyses showed that the effect of finerenone on eGFR slope was consistent across subgroups defined by primary CKD cause (hypertension/ischemic nephropathy, chronic glomerulonephritis, and other), baseline eGFR, baseline urinary albumin-to-creatinine ratio (UACR; ≤1000 and >1000 mg/g), and concomitant sodium-glucose cotransporter 2 (SGLT2) inhibitor use. Finerenone also significantly reduced the risk of the composite kidney-cardiovascular endpoint (sustained ≥57% decrease in eGFR for >4 weeks, kidney failure, hospitalisation for heart failure, or cardiovascular death) compared with placebo (HR 0.77; 95% CI 0.60–0.99; P=0.043). Adverse events leading to discontinuation were more common with finerenone, whereas those leading to death were more common with placebo (1.3% vs 0.8%). Hyperkalaemia, a known class effect, was reported in 17.0% of patients receiving finerenone and 13.3% of those receiving placebo.

“This international, phase 3 clinical trial met its primary endpoint,” concluded Prof. Heerspink. “Finerenone reduced the mean annual rate in eGFR from baseline to month 32 and reduced the risk of the composite kidney-cardiovascular endpoint compared with placebo. Although there was a higher incidence of hyperkalaemia, the clinical impact was minimal.”

Heerspink HJL, et al. Finerenone in patients with chronic kidney disease. ERA 2026, 3–6 June. Glasgow, Scotland.