FIND-CKD: Finerenone in Non-Diabetic CKD Extending kidney and cardiovascular protection beyond diabetic kidney disease

Authors

  • Dr. Pallavi Mishra, MBBS, MD (Medicine), KGMU M.Sc Cardiology, South Wales Diabeteto -Cardiologist Women cardiologist Echocardiography Specialist English Author

Keywords:

Finerenone, FIND‑CKD, Non‑diabetic CKD, Albuminuria, Cardiorenal protection, Nonsteroidal MRA

Abstract

Abstract 
Background: Evidence for finerenone has primarily come from trials in diabetic kidney disease; FIND‑CKD aimed to evaluate its efficacy and safety in non‑diabetic CKD and was incorporated into an individual participant‑data meta‑analysis published in The Lancet.

Methods and population: The pooled analysis combined FIND‑CKD with FIDELIO‑DKD and FIGARO‑DKD, yielding 14,574 participants (mean age 63.7 years; 30.7% female), mean eGFR 56.4 mL/min/1.73 m², and median UACR 567.4 mg/g. Follow‑up encompassed contemporary care including RAS blockade and SGLT2‑inhibitor use. Primary outcomes included a composite kidney endpoint (kidney failure or sustained ≥57% eGFR decline) and a composite cardiovascular endpoint (heart‑failure hospitalization or cardiovascular death).

Results: Finerenone reduced the composite kidney outcome by 24% (HR 0.76, 95% CI 0.68–0.86) and the composite cardiovascular outcome by 20% (HR 0.80, 95% CI 0.70–0.91). Heart‑failure hospitalization (HR 0.78) and all‑cause mortality (HR 0.88) were also favorably impacted. Crucially, kidney benefit was consistent regardless of glycaemic status, CKD aetiology, baseline eGFR, degree of albuminuria, and concurrent SGLT2‑inhibitor therapy.

Conclusions and implications: FIND‑CKD extends finerenone’s demonstrable kidney and cardiovascular benefits to non‑diabetic, albuminuric CKD, supporting use when residual albuminuria persists despite RAS and SGLT2 blockade and potassium monitoring is available. These results expand the therapeutic toolkit for a previously underserved CKD population and align with guideline recommendations positioning nonsteroidal MRAs as add‑on organ‑protective therapy.

NEWSLETTER 11 FIND-CKD: Finerenone in Non-Diabetic CKD Extending kidney and cardiovascular protection beyond diabetic kidney disease Figure 11. FIND-CKD: Finerenone in Non-Diabetic CKD — mechanism overview (illustrative; labels added for education). FIND-CKD (NCT05047263) was a randomised, double-blind, placebo-controlled trial of finerenone in chronic kidney disease conducted from September 21, 2021 to February 2, 2026, and it was included in an individual participant-data meta-analysis published in The Lancet on June 13, 2026 by Neuen and colleagues.1 Its central contribution is evidence for finerenone in non-diabetic CKD—a population historically underserved by cardiorenal trials. The pooled analysis combined FIND-CKD with FIDELIO-DKD and FIGARO-DKD, enrolling 14,574 participants with a mean age of 63.7 years, 30.7% female, a mean eGFR of 56.4 mL/min/1.73 m², and a median UACR of 567.4 mg/g—reflecting a substantially albuminuric, at-risk cohort.1 Efficacy was robust. Finerenone reduced the composite kidney outcome—kidney failure or a sustained ≥57% decline in eGFR—by 24% (HR 0.76, 95% CI 0.68–0.86).1 The composite cardiovascular outcome of heart-failure hospitalisation or cardiovascular death was reduced by 20% (HR 0.80, 95% CI 0.70–0.91), with heart-failure hospitalisation at HR 0.78 and all-cause death at HR 0.88.1 Crucially, the kidney benefit was consistent irrespective of glycaemic status, CKD aetiology, baseline eGFR, albuminuria, and SGLT2-inhibitor use—the key finding supporting use in non-diabetic CKD.1 This consistency means clinicians need not withhold finerenone simply because a patient does not have diabetes, provided albuminuria and appropriate potassium monitoring are in place. The trial’s recruitment window is worth noting: FIND-CKD ran from September 2021 to February 2026, making it one of the most contemporary datasets informing the 2026 guidelines.1 Its cohort was substantially albuminuric, with a median UACR of 567.4 mg/g and mean eGFR of 56.4 mL/min/1.73 m²—precisely the high-risk phenotype in which residual albuminuria persists despite RAS and SGLT2 blockade, and in which the guideline positions a nonsteroidal MRA as the logical next step.1,5 These results align with the broader INFINITY pooled analysis, which likewise found finerenone’s benefits held regardless of diabetic versus non-diabetic CKD.2 Together, FIND-CKD and INFINITY broaden the evidence-based indication for finerenone and reinforce the 2026 guideline’s positioning of nonsteroidal MRAs as add-on kidney- and heart-protective therapy when albuminuria persists on RAS inhibitors plus SGLT2 inhibitors.5 For nephrology and endocrinology practice, this expands the toolkit for a large and previously under-treated CKD population. References 1. Efficacy and safety of finerenone in CKD (FIND-CKD/FIDELIO/FIGARO pooled), Lancet, June 13, 2026 (PMID 42248158). https://pubmed.ncbi.nlm.nih.gov/42248158/ 2. Bayer's INFINITY Analysis Shows Finerenone Delivers Long-Term Kidney and Heart Protection, Clival, June 9, 2026. https://clival.com/news/bayers-infinity-analysis-shows-finerenone-delivers-long-term-kidney-and-heart-protection-in-chronic-kidney-disease 3. FINE-HEART pooled analysis (cancer subanalysis), Eur J Heart Fail, June 29, 2026. https://academic.oup.com/eurjhf/article/28/Supplement_2/xuag193.1363/8721035 4. Finerenone May Cut Sudden Death Risk Across the CKM Spectrum, Medscape, June 16, 2026. https://www.medscape.com/viewarticle/finerenone-may-cut-risk-sudden-death-across-ckm-spectrum-2026a1000kau 5. 2026 CKM Guideline — Top Things to Know, professional.heart.org, June 9, 2026. https://professional.heart.org/en/science-news/2026-guideline-for-the-prevention-detection-evaluation-and-management-of-ckm-syndrome/top-things-to-know 6. KDIGO 2026 Diabetes and CKD Guideline Update Public Review Draft, March 2026. https://kdigo.org/wp-content/uploads/2026/03/KDIGO-2026-Diabetes-and-CKD-Guideline-Update-Public-Review-Draft-March-2026.pdf

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Published

2026-07-07

Issue

Vol. 4 No. 11 (2026): FIND-CKD: Finerenone in Non-Diabetic CKD Extending kidney and cardiovascular protection beyond diabetic kidney disease

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Articles

How to Cite

FIND-CKD: Finerenone in Non-Diabetic CKD Extending kidney and cardiovascular protection beyond diabetic kidney disease. (2026). Diabzen, 4(11), 22-23. https://thediabzen.com/index.php/d/article/view/51

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