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June 4, 2026New England Journal of Medicine
Finerenone in Persons with Chronic Kidney Disease without Diabetes
Key result
Finerenone slows eGFR decline by ~18% vs placebo in non-diabetic CKD.
- MD +0.7
- 95% CI 0.3 to 1.1
- P<0.001
- n=1,584
Why the study?
Whether finerenone improves kidney and cardiovascular outcomes in patients with chronic kidney disease without diabetes was unknown.
Does finerenone improve the rate of eGFR decline in adults with chronic kidney disease without diabetes?
Key Points
- To determine whether finerenone improves kidney and cardiovascular outcomes in individuals with chronic kidney disease who do not have diabetes.
- Randomized clinical trial (NCT05047263) assigning 1584 adults without diabetes who had chronic kidney disease (eGFR 25 to <90 ml/min/1.73 m², UACR 200 to ≤3500 mg/g) receiving RAS inhibitors to finerenone (10 or 20 mg daily; n=793) or placebo (n=791).
- Assessed the primary outcome of total eGFR slope from baseline to month 32 via a two-slope linear spline mixed-effects model alongside secondary composite kidney and cardiovascular outcomes.
- The mean annual change in eGFR over 32 months was −3.3 ml/min/1.73 m² (95% CI, −3.6 to −3.1) with finerenone versus −4.0 ml/min/1.73 m² (95% CI, −4.3 to −3.8) with placebo (difference, 0.7; 95% CI, 0.3 to 1.1; P<0.001).
- Hyperkalemia was reported in 17.0% (n=135) of finerenone recipients and 13.3% (n=105) of placebo recipients, prompting regimen discontinuation in 1.5% and 0.1% of participants, respectively.
Study Design
Type
RCT (n=1,584)
Randomization
randomized
Structured PICO
Does finerenone improve the rate of eGFR decline in adults with chronic kidney disease without diabetes?
P
Population
1,584 adults without diabetes who had CKD and albuminuria on a renin-angiotensin system inhibitor, followed for 32 months.
I
Intervention
Finerenone 10 or 20 mg daily added to background renin-angiotensin system inhibitor therapy
C
Comparator
Placebo added to background renin-angiotensin system inhibitor therapy
O
Outcome
Total eGFR slope (mean annual rate of change in the eGFR from baseline to month 32)surrogate
Main Result
Mean Difference: 0.7 (95% CI 0.3–1.1)
Absolute Event Rate: -3.3% vs -4%
p-value: p=<0.001
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Key expert perspectives
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“The FIND-CKD results provide important Phase III data on finerenone's potential for adults living with non-diabetic chronic kidney disease. Despite available treatments, there remains a critical unmet need.”
HLHiddo L. HeerspinkProfessor of Clinical Trials, University Medical Center Groningen
“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.”
HLHiddo L. HeerspinkProfessor of Clinical Trials, University Medical Center Groningen
“The FIND-CKD results are encouraging because they show the benefits of finerenone in preserving kidney function in a dedicated study across several etiologies of non-diabetic chronic kidney disease.”
Implication
In adults with non-diabetic chronic kidney disease, finerenone significantly slowed the decline of kidney function and reduced the risk of composite kidney or cardiovascular events compared to placebo.
Abstract
Background: In randomized trials, finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improved kidney and cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease (CKD). Whether finerenone has similar effects in patients without diabetes who have CKD is unknown. Methods: We randomly assigned adults without diabetes who had CKD (estimated glomerular filtration rate [eGFR], 25 to <90 ml per minute per 1.73 m 2 of body-surface area) and albuminuria (urinary albumin-to-creatinine ratio, 200 to ≤3500, with albumin in milligrams and creatinine in grams) and were using a renin–angiotensin system inhibitor to receive finerenone (10 or 20 mg daily) or placebo. The primary outcome was the total eGFR slope (mean annual rate of change in the eGFR from baseline to month 32), assessed with a two-slope linear spline mixed-effects model. Secondary outcomes included a composite of kidney or cardiovascular events (reduction from baseline of at least 57% in the eGFR, kidney failure, hospitalization for heart failure, or death from cardiovascular causes), a composite of the two kidney events, and a composite of the two cardiovascular events. Results: A total of 1584 participants underwent randomization — 793 were assigned to the finerenone group, and 791 to the placebo group. The mean (±SD) baseline eGFR was 46.8±16.2 ml per minute per 1.73 m 2 with finerenone and 46.6±16.0 ml per minute per 1.73 m 2 with placebo. The mean annual rate of change in the eGFR from baseline to month 32 was −3.3 ml per minute per 1.73 m 2 (95% confidence interval [CI], −3.6 to −3.1) with finerenone and −4.0 ml per minute per 1.73 m 2 (95% CI, −4.3 to −3.8) with placebo (difference, 0.7; 95% CI, 0.3 to 1.1; P<0.001). Prespecified hierarchical testing showed that the risk of a composite kidney or cardiovascular outcome event was lower with finerenone than with placebo (hazard ratio, 0.77; 95% CI, 0.60 to 0.99; P=0.04); the hazard ratio was 0.78 (95% CI, 0.60 to 1.01) for the composite of the two kidney events and 0.60 (95% CI, 0.27 to 1.33) for the composite of the two cardiovascular events. The most common adverse event was hyperkalemia (135 participants [17.0%] with finerenone and 105 [13.3%] with placebo); hyperkalemia events led to discontinuation of the trial regimen in 12 participants (1.5%) and 1 participant (0.1%), respectively, and to hospitalization in 7 (0.9%) and 5 (0.6%). Conclusions: Among adults with CKD who did not have diabetes, finerenone led to a slower decrease in the eGFR than placebo over 32 months. (Funded by Bayer; FIND-CKD ClinicalTrials.gov number, NCT05047263 .)
Cite This Study
Heerspink et al. (2026) conducted an RCT in Chronic Kidney Disease without Diabetes (n=1,584). Finerenone vs. placebo was evaluated on total eGFR slope (mean annual rate of change in the eGFR from baseline to month 32) (MD 0.7, 95% CI 0.3 to 1.1, p=<0.001). Finerenone led to a slower decrease in eGFR than placebo over 32 months in adults with CKD without diabetes (difference 0.7 ml/min/1.73 m2; 95% CI 0.3 to 1.1; P<0.001).