Finerenone, already used for diabetic kidney disease, reduced major kidney complications and slowed renal decline in a randomized NEJM trial of 1,584 adults with non‑diabetic CKD. The drug produced a ~23% relative reduction in major kidney events (13.9% vs 16.9%) and lowered urine protein by >41% at six months versus ~9% with placebo. Patients remained on ACE inhibitor or ARB therapy, were followed for just over three years on average, and finerenone was generally well tolerated, suggesting it could become an add‑on option for non‑diabetic CKD.
Finerenone Slows Kidney Decline in Non‑Diabetic CKD Patients, NEJM Trial Finds
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A drug already approved for diabetic kidney disease, finerenone, may soon help a much broader group of patients. A randomized trial published in the New England Journal of Medicine found that finerenone slowed loss of kidney function and reduced major kidney complications in people with chronic kidney disease (CKD) who do not have diabetes.
Key Findings
The study enrolled 1,584 adults with non‑diabetic CKD who had reduced kidney function and elevated urinary protein, both markers of kidney damage. All participants continued standard therapy with an ACE inhibitor or an angiotensin receptor blocker (ARB) and were randomized to finerenone or placebo, then followed for just over three years on average.
Investigators reported that finerenone reduced the risk of major kidney complications from 16.9% in the placebo group to 13.9% in the finerenone group — a relative risk reduction of approximately 23% and an absolute risk reduction of about 3 percentage points (roughly an estimated number needed to treat of ~34 over the trial period). Urine protein fell by more than 41% at six months with finerenone versus about 9% with placebo, indicating reduced ongoing kidney injury.
Safety and Context
Finerenone was tested as an add‑on to guideline‑directed ACE inhibitor or ARB therapy rather than as a replacement for current treatments. The trial reported that the drug was generally well tolerated in this non‑diabetic CKD population, supporting the possibility of broader use. Experts caution, however, that medications are most effective when CKD is detected early, before irreversible damage occurs.
"Finerenone could become an important new treatment option for people with chronic kidney disease who do not have diabetes," said lead investigator Hiddo Lambers Heerspink of University Medical Center Groningen.
Why This Matters
According to the World Health Organization, about 674 million adults worldwide live with CKD, and more than half of those patients do not have diabetes. Because prior finerenone research focused mainly on people with diabetes, this trial addresses an important unmet need for effective therapies in the non‑diabetic CKD population.
While the results are promising, adoption into routine care will depend on guideline reviews, regulatory considerations, cost, and additional real‑world data. Nonetheless, finerenone adds a potential new option that can be combined with existing kidney‑protective medications.
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