A new analysis of over 14,000 patients reveals that finerenone, a non-steroidal mineralocorticoid receptor antagonist (ns-MRA), significantly protects both kidneys and the heart across all types of chronic kidney disease (CKD), not just in diabetic patients. The findings, presented at the European Renal Association's annual congress and published in the Lancet, suggest that treatment guidelines may need to expand to include this drug for a much broader population of kidney disease patients.

Chronic kidney disease affects nearly 800 million people worldwide, yet most don't realize they have it. The condition damages the kidneys' ability to filter waste from the blood, and it often leads to serious heart problems. Until recently, most kidney-protective medications were tested primarily in patients with type 2 diabetes. This new research changes that picture by showing finerenone works across the board.

What Did the Study Actually Find?

Researchers led by Dr. Rajiv Agarwal conducted INFINITY, a pooled analysis combining data from three major clinical trials involving 14,574 patients with CKD and well-controlled blood pressure. The study tracked patients for an average of 3.1 years and measured two main outcomes: kidney failure or severe kidney function decline, and heart-related complications like hospitalization for heart failure or cardiovascular death.

The results were striking. Over the study period, finerenone reduced the risk of kidney failure or a sustained 57% or greater decline in kidney function (measured by estimated glomerular filtration rate, or eGFR) by 24% compared to placebo. This translated to 22.3 events per 1,000 patient-years with finerenone versus 28.8 with placebo. For heart outcomes, finerenone lowered the composite cardiovascular risk by 20%, with 19.1 events per 1,000 patient-years versus 23.9 with placebo. The drug also showed promise for reducing all-cause death by 12%, though this finding had a wider margin of uncertainty.

What makes this particularly important is that these benefits appeared consistently across different patient groups. Whether someone had diabetes or not, had early or advanced kidney disease, or was already taking other kidney-protective medications like SGLT2 inhibitors, finerenone delivered similar protection.

How Does Finerenone Work, and Is It Safe?

Finerenone belongs to a newer class of drugs called non-steroidal mineralocorticoid receptor antagonists. Unlike older drugs in this category, it doesn't significantly raise potassium levels in the blood, which was a major limitation of previous treatments. However, the study did find that hyperkalemia (elevated potassium) occurred more frequently with finerenone than placebo: 14.3% versus 7.6%. The good news is that this side effect rarely led to serious consequences. Only 1.7% of patients on finerenone had to stop the drug due to hyperkalemia, and hospitalizations or deaths from this complication were extremely rare.

Overall, serious adverse events and rates of acute kidney injury were similar between the finerenone and placebo groups, suggesting the drug is well-tolerated in most patients.

What This Means for Treatment Guidelines

The implications of this research are substantial. Currently, the standard approach to protecting kidneys and the heart in CKD patients involves a combination of three drug classes: renin-angiotensin system blockers (like ACE inhibitors), SGLT2 inhibitors, and now potentially finerenone. In an editorial accompanying the Lancet publication, kidney specialists Alberto Ortiz and Beatriz Fernandez-Fernandez noted that these findings should expand this triple-drug approach beyond diabetic patients to include non-diabetic CKD, provided patients meet the study's entry criteria.

"FIND-CKD and INFINITY have demonstrated clinically relevant benefit for finerenone to improve kidney, cardiovascular, and survival outcomes regardless of diabetes in people with CKD," stated Katherine Tuttle, a co-investigator and physician at Providence Health Care and Institute of Translational Health Sciences.

Katherine Tuttle, MD, Providence Health Care and Institute of Translational Health Sciences

This represents a significant shift in how nephrologists (kidney specialists) may approach treatment. For decades, kidney disease management has been somewhat one-size-fits-all, with the same drugs recommended across different patient populations. The INFINITY analysis suggests that a more personalized, multi-drug strategy targeting different pathways of kidney and heart damage could benefit a much larger group of patients.

Who Would Benefit From Finerenone?

The study included patients with specific characteristics, which helps clarify who might benefit most from this treatment. Eligible patients had:

• Kidney Function Level: An eGFR of at least 25 mL/min/1.73 m2, meaning they had mild to moderate kidney disease but weren't yet on dialysis
• Potassium Levels: A serum potassium of 4.8 mmol/L or less, indicating their kidneys could still handle the drug without dangerous potassium buildup
• Protein in Urine: Elevated urinary albumin-to-creatinine ratio (UACR), a sign of kidney damage; diabetic patients needed at least 30 mg/g, while non-diabetic patients needed at least 200 mg/g depending on their eGFR level

The study excluded patients with certain conditions, such as those with immunological kidney diseases requiring immunosuppressive therapy, cystic kidney diseases, or heart failure with reduced ejection fraction. This means finerenone isn't appropriate for everyone with kidney disease, and doctors will need to carefully select which patients are good candidates.

Steps to Take If You Have Chronic Kidney Disease

If you've been diagnosed with CKD or are at risk, here's what experts recommend:

• Get Regular Monitoring: Have your kidney function checked regularly through blood tests measuring eGFR and urine tests measuring protein levels, as early detection and treatment can slow disease progression
• Manage Blood Pressure and Blood Sugar: Keep your blood pressure well-controlled and manage diabetes if you have it, since these are the two biggest risk factors for worsening kidney disease
• Discuss Medication Options With Your Doctor: Ask your nephrologist whether you might be a candidate for newer kidney-protective medications like SGLT2 inhibitors or finerenone, especially if you have proteinuria (protein in your urine)
• Maintain a Healthy Lifestyle: Avoid obesity, limit sodium intake, stay physically active, and follow any dietary recommendations your care team provides

The INFINITY analysis represents a watershed moment in kidney disease treatment. By demonstrating that finerenone works across diverse patient populations, it opens the door to more aggressive, multi-targeted approaches that could help millions of people preserve their kidney function and protect their hearts. As these findings make their way into clinical practice guidelines, patients with CKD may soon have access to more powerful treatment options, regardless of whether they have diabetes.