A groundbreaking study shows that finerenone, a medication previously tested mainly in diabetic patients, can slow kidney function decline and reduce serious heart and kidney complications in people with chronic kidney disease who don't have diabetes. The findings, presented at the European Renal Association's 2026 congress, expand treatment options for millions of people living with kidney disease regardless of their diabetes status.

What Is Finerenone and How Does It Work?

Finerenone is a medication that works by blocking a specific protein in the body involved in kidney and heart damage. Researchers tested it in a large, rigorous study called FIND-CKD, which included 1,584 participants with chronic kidney disease (CKD), a condition where the kidneys gradually lose their ability to filter waste from the blood. The study compared finerenone at two different doses (10 mg and 20 mg daily) against a placebo, with all participants also receiving standard kidney-protective medications.

How Much Does Finerenone Slow Kidney Decline?

The results were compelling. Over 32 months, kidney function declined at a rate of 3.3 mL/min/1.73 m² per year in the finerenone group, compared to 4.0 mL/min/1.73 m² per year in the placebo group. This represents a meaningful 0.7 mL/min/1.73 m² difference, meaning finerenone slowed the decline in kidney function by roughly 18%. While kidney function initially dipped slightly in the first three months of treatment, it then stabilized and improved during the longer-term follow-up period.

Beyond slowing kidney decline, finerenone reduced the risk of a composite outcome combining serious kidney and heart events by 23%, including severe kidney function loss, kidney failure, hospitalization for heart failure, or death from cardiovascular causes. This dual benefit on both kidney and heart health is particularly important because people with kidney disease face elevated risks for both organs.

"We now have a very important pillar that expands the options for most people with chronic kidney disease, regardless of diabetes status," said Katherine Tuttle, MD, co-investigator at the University of Washington.

Katherine Tuttle, MD, Co-Investigator at University of Washington

Who Participated in the Study?

The FIND-CKD trial enrolled a diverse group of patients with different causes of kidney disease. The underlying causes of kidney disease in the study population included:

• Hypertensive or ischemic nephropathy: Kidney damage from high blood pressure or reduced blood flow, affecting approximately 28-30% of participants
• Chronic glomerulonephritis: Long-term inflammation of the kidney's filtering units, present in 56-58% of participants
• Other causes: Various less common etiologies accounting for 3-4% of the group
• Unknown causes: About 10-11% of participants had kidney disease of undetermined origin

At the start of the study, participants had an average estimated glomerular filtration rate (eGFR), a measure of kidney function, of approximately 47 mL/min/1.73 m², indicating moderate kidney disease. The study excluded patients with certain genetic or autoimmune kidney conditions to focus on the most common forms of non-diabetic kidney disease.

What About Side Effects?

Safety was an important consideration. The overall rate of adverse events was similar between the finerenone and placebo groups (68.3% versus 65.4%, respectively). However, finerenone did increase the risk of elevated potassium levels in the blood, a known concern with this class of medication. Rates of any hyperkalemia (high potassium) were 17.0% with finerenone versus 13.3% with placebo. Despite this increase, the clinical impact was minimal; only 1.5% of finerenone users discontinued the drug due to high potassium, and hospitalizations for this complication occurred in less than 1% of patients.

"Finerenone met its primary and key secondary endpoints versus placebo. It reduced the mean annual rate of change in kidney function and reduced the composite kidney-cardiovascular outcome. Although there was a higher incidence of hyperkalemia with finerenone than placebo, its clinical impact was minimal," stated Hiddo Lambers Heerspink, PhD, of the University Medical Center Groningen.

Hiddo Lambers Heerspink, PhD, University Medical Center Groningen

How Does This Compare to Previous Research?

The magnitude of benefit seen in this non-diabetic population mirrors what researchers observed in earlier trials of finerenone in diabetic kidney disease, as well as results from studies of SGLT2 inhibitors (sodium-glucose cotransporter-2 inhibitors), another class of kidney-protective drugs. This consistency across different patient populations strengthens confidence in finerenone's effectiveness. The benefits were generally consistent across different subgroups defined by kidney function level, protein in the urine, and whether patients were also taking SGLT2 inhibitors.

Steps to Understanding Your Kidney Health

• Know your eGFR: Ask your doctor for your estimated glomerular filtration rate, a key number that reflects how well your kidneys are filtering waste; normal is 90 or higher
• Monitor protein in urine: Your doctor may measure albumin-to-creatinine ratio (UACR) to detect early kidney damage; higher levels suggest more advanced disease
• Discuss medication options: If you have chronic kidney disease, talk with your nephrologist about kidney-protective medications like finerenone or SGLT2 inhibitors that may slow disease progression
• Control blood pressure and blood sugar: Managing these conditions is fundamental to slowing kidney disease; work with your healthcare team to reach target goals

What Does This Mean for Patients?

For the estimated 37 million Americans with chronic kidney disease, most of whom don't have diabetes, these findings represent meaningful progress. Finerenone offers a new tool to slow kidney decline and reduce the risk of serious complications. The medication's effectiveness across different types of non-diabetic kidney disease suggests it could benefit a broad population. However, patients will need close monitoring of potassium levels, particularly those with more advanced kidney disease or those taking other medications that raise potassium. The decision to start finerenone should be made in consultation with a nephrologist or kidney specialist who can assess individual risk and benefit.