Finerenone in hypertensive non-diabetic chronic kidney disease: a FIND-CKD subgroup analysis
Key result
Finerenone slows eGFR decline and cuts kidney-CV events ~39% vs placebo in hypertensive nephropathy.
- MD 0.65
- 95% CI 0.02, 1.29
- P=.044
- n=459
Why the study?
Hypertension commonly causes CKD and mineralocorticoid receptor overactivation drives progression, but finerenone efficacy and safety specifically in hypertensive nephropathy required assessment.
Does finerenone reduce kidney function decline in adults with hypertensive non-diabetic chronic kidney disease?
Population
459 participants with hypertensive nephropathy from the randomized FIND-CKD trial
Comparison
Once-daily finerenone vs placebo
Design
Prespecified randomized trial subgroup analysis
Follow-up
Month 32
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A pre-specified subgroup analysis of the Phase III FIND-CKD study found that finerenone slowed kidney function decline compared with placebo in addition to standard of care in patients with hypertensive nephropathy, a population for whom there are only few guideline-directed treatment options. For clinicians, the findings offer new insights into the benefits of finerenone in cardio-kidney health protection in patients with hypertensive nephropathy.”
“The findings represent the first randomized placebo-controlled evidence evaluating finerenone in adults with CKD without diabetes. It really removes the need to extrapolate from diabetic trials.”
UUnattributedMedical Writer
“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 events.”
Implication
Supports finerenone in hypertensive non-diabetic CKD; extends RCT evidence to this etiology.
Key Points
- To assess the efficacy and safety of finerenone on kidney function decline and composite cardiovascular-kidney outcomes in non-diabetic chronic kidney disease with hypertensive nephropathy.
- Prespecified subgroup analysis of the randomized, 1:1 placebo-controlled FIND-CKD trial (NCT05047263) evaluating 459 participants with investigator-reported hypertensive nephropathy out of 1584 randomized adults (baseline eGFR 25 to <90 mL/min/1.73 m2, UACR 200–3500 mg/g).
- Participants received once-daily finerenone or placebo, with outcomes assessing total eGFR slope to Month 32 and a composite outcome of sustained ≥57% eGFR decline, kidney failure, heart failure hospitalization, or cardiovascular death.
- Finerenone slowed total eGFR decline versus placebo by 0.65 mL/min/1.73 m2/year (95% CI: 0.02, 1.29; P = .044) and reduced composite kidney-cardiovascular events (HR: 0.61; 95% CI: 0.38, 0.99; P = .045).
- Finerenone reduced systolic blood pressure by -3.5 mmHg and urinary albumin-to-creatinine ratio by 33% at Month 6 compared to placebo.
- Hyperkalaemia occurred in 17.1% of finerenone-treated participants versus 9.8% with placebo, resulting in treatment discontinuation in 1.3% and 0.0% of patients, respectively.
Study Design
Type
RCT (n=459)
Randomization
1:1
Structured PICO
Does finerenone reduce kidney function decline in adults with hypertensive non-diabetic chronic kidney disease?
P
Population
459 adults with hypertensive nephropathy, eGFR 25-<90 mL/min/1.73 m2, and UACR 200-3500 mg/g, followed for up to 32 months.
I
Intervention
Finerenone once-daily
C
Comparator
Placebo
O
Outcome
Total eGFR slope from baseline to Month 32surrogate
Main Result
Mean Difference: 0.65 (95% CI 0.02–1.29)
p-value: p=.044
In patients with hypertensive non-diabetic chronic kidney disease, finerenone significantly slowed eGFR decline and reduced the risk of composite kidney-cardiovascular events compared to placebo.
Cite This Study
Heerspink et al. (2026) conducted an RCT in hypertensive nephropathy (n=459). Finerenone vs. placebo was evaluated on Total eGFR slope from baseline to Month 32 (MD 0.65, 95% CI 0.02, 1.29, p=.044). Finerenone slowed total eGFR decline by 0.65 mL/min/1.73 m2/year (95% CI 0.02-1.29; P=0.044) and reduced composite kidney-cardiovascular events (HR 0.61) versus placebo in hypertensive nephropathy.