Professor Vlado Perkovic

Finerenone, one of the four pillars of treatment for diabetic kidney disease along with a RASI, SGLT2i and GLP-1 RA, should also be added to the management of non-diabetic kidney disease.

Heading up a panel of speakers from the FIND-CKD study, Professor Vlado Perkovic from UNSW Sydney told the ERA Congress that people with non-diabetic kidney disease have been underrepresented in past clinical trials leading to limited disease-modifying therapies.

There were also other challenges for this patient group.

”It’s often diagnosed late. There are an array of different causes providing a variable presentation, and despite our currently proven therapies, there’s still an ongoing risk of progression leading to kidney failure and cardiovascular complications,” he said.

“While we have now four proven pillars of treatment for people with diabetic kidney disease, we’ve only had two to date in non-diabetic kidney disease, meaning that the foundation for our therapy is much more unstable for our patients, and additional therapies are urgently required.”

The FIND-CKD study, concurrently published in the NEJM [link here], randomised 1,584 patients from 24 countries including Australia to finerenone (10 or 20 mg daily) or placebo. Participants were adults without diabetes who had CKD and eGFR of 25-59 mL/min/1.73m².

As per inclusion criteria, almost all participants (99.7%) were receiving a RAS inhibitor while 17.0% were receiving a SGLT2 inhibitor, with the proportion increasing during the study.

Most patients (57%) had chronic glomerulonephritis as the primary cause of their CKD and 29% had hypertensive or ischaemic nephropathy.

Efficacy

Presenting the main results of the study, Professor Hiddo Heerspink told the meeting the total eGFR slope after three years was -3.3 mL/min/1.73m² with finerenone versus -4.0 mL/min/1.83m² with placebo (p =0.0003).

From the end of treatment to the end of follow-up, the mean eGFR increased with finerenone and decreased with placebo.

Professor Heeerspink, from the University of Groningen in the Netherlands, said the effect of finerenone on the total GFR slope was consistent in pre-specified subgroups.

“Finerenone reduced the total GFR slope, irrespective of whether patients had hypertension, ischemic nephropathy, chronic glomerulonephritis, or when the chronic kidney disease was other or unknown. Results were also consistent… whether or not patients were using SGLT2 inhibitors at baseline,” he said.

“Now the important question is, of course, whether these benefits on total GFR slope will translate into benefits on the clinical kidney-cardiovascular outcome.

In secondary and exploratory outcomes:

• The composite outcome of kidney or cardiovascular events occurred in 13.9% of the finerenone group v 16.9% in the placebo group (HR 0.77; p0.04)
• The kidney events alone – kidney failure or sustained ≥57% eGFR decrease – occurred in 13.1%of the finerenone group v 15.8% in the placebo group (HR 0.78)
• The cardiovascular endpoint of HF hospitalisation or CV death was infrequent, occurring in 1.3% of the finerenone group v 2.0% of the control group (HR 0.60).
• Kidney failure or sustained ≥40% eGFR decrease occurred in 21.2% of the finerenone group v26.0% of the control group (HR 0.76).
• Finerenone also reduced albuminuria with UACR by 35.4% at 6 months.
• Finernone patients experienced an early, modest rise in serum potassium which maintained at about 0.12 mmol/L higher than the placebo group.

Safety profile

Finerenone was safe and well tolerated in the study with comparable rates of adverse events and serious adverse events in both treatment groups and very few leading to permanent drug discontinuation or death.

Investigator-reported hyperkalemia adverse events were more often seen in the finerenone group (17%) compared to the placebo group (13.3%) and led to hospitalisation in 0.9% versus 0.6%, respectively. Permanent discontinuation of the trial regimen occurred in 1.5% and 0.1%, respectively, while there were no fatal hyperkalemia events.

A/Prof Brendon Neuen

Glomerular disease

Associate Professor Brendon Neuen, from the George Institute for Global Health, presented the results from the subset of 903 patients with glomerular disease not treated by immunosuppression within 6 months of screening. The study was concurrently published in JAMA [link here].

Participants had diagnosis of had IgA nephropathy (46.1%), focal segmental glomerulosclerosis (23.8%), membranous nephropathy (10.0%), membranoproliferative glomerulonephritis (2.9%), and other glomerular diseases (17.3%).

“In this pre-specified, exploratory subgroup analysis of the FIND-CKD trial, fenerenone compared to placebo slowed the annualised rate of eGFR decline, reduced albuminuria, and was associated with a lower risk of the composite outcome of kidney failure or sustained ≥40% decline in eGFR in patients with glomerular diseases, including across a range of different glomerular disease subtypes,” he said.

“Finerenone was well tolerated in patients with glomerular diseases, with a safety profile that was overall in keeping with the overall trial population.”

Meta-analysis

Professor Rajiv Agarwal, from the Indiana University, presented the results of an individual participant data pooled analysis of the FIDELIO-DKD, FIGARO-DKD, and FIND-CKD studies, concurrently published in The Lancet [link here].

The INFINITY meta-analysis, comprising over 14,500 patients with and without diabetes, found finerenone:

• reduced the risk of the composite kidney outcome by 24% versus placebo, with no modification by diabetes status
• reduced the risk of kidney failure by 15%
• reduced the risk of dialysis or kidney transplantation by 23%
• reduced the composite cardiovascular outcome by 20%
• reduced all-cause death by 12%.

An accompanying comment article in The Lancet [link here] said the findings of FIND-CKD and INFINITY should change guidelines and expand cardio-kidney protection in patients with non-diabetic CKD to include RASi, SGLT2i and finerenone.

Professor Kathy Tuttle, from the University of Washington, summed up the ERA session saying FIND-CKD and INFINITY demonstrate clinically relevant benefits with finerenone improving kidney, cardiovascular and survival outcomes regardless of diabetes.

“Now, regardless of the presence or absence of diabetes in people with CKD, our job… is to increase CKD awareness and detection, and timely use of interventions. These are urgently needed if we want to achieve our aspirational goal to preserve kidney and heart function and save the lives of millions of people worldwide.”

FIND-CKD was funded by Bayer.

🚨 Finerenone breaks the diabetes barrier!

The landmark FIND-CKD trial (NEJM 2026) demonstrates that finerenone significantly reduces albuminuria, slows eGFR decline, and improves cardiorenal outcomes in patients with proteinuric CKD without diabetes.@ISNkidneycare @isn_india pic.twitter.com/vdcMR6dIPd

— Dr Manish Singla (@KidneyDrSingla) June 6, 2026