A series of major studies has shown that finerenone preserves kidney function, reduces cardiovascular risk, and improves survival across a much broader range of patients with chronic kidney disease (CKD) than it is currently recommended for. These benefits extend beyond diabetes to non-diabetic CKD and glomerular diseases.
The findings were presented today at the European Renal Association Congress in Glasgow, UK and simultaneously published in three of the world’s leading medical journals The Lancet, The New England Journal of Medicine and JAMA – a rare achievement in clinical research.
Finerenone is a non-steroidal mineralocorticoid receptor antagonist currently approved for the treatment of CKD associated with type 2 diabetes.1 Overactivation of the mineralocorticoid receptor drives inflammation and fibrosis across many forms of kidney disease, prompting researchers at The George Institute for Global Health to evaluate its potential in a broader population of patients with CKD than currently indicated.
The FIND-CKD trial, led by The George Institute’s Professor Hiddo Heerspink and UNSW Sydney’s Professor Vlado Perkovic, assessed finerenone in 1,584 patients with non-diabetic CKD from 24 countries. When added to standard care, finerenone significantly slowed kidney function decline. The trial also showed that finerenone reduced the risk of kidney failure, CKD progression, heart failure, or cardiovascular death by 23%. These results were published in The New England Journal of Medicine.2
A second study, led by The George Institute’s Associate Professor Brendon Neuen and published in JAMA,3 focused on a subset of patients in the FIND-CKD trial who had glomerular diseases - a group of conditions characterised by immune-mediated kidney damage for which few treatment options are available. In these patients, finerenone reduced the risk of kidney failure or CKD progression by 26% compared with placebo and lowered albuminuria, or protein in the urine — a key marker of kidney damage — by 42% at 12 months.
In a third analysis, also led by A/Prof Neuen and published in The Lancet,4 researchers pooled data from FIND-CKD with two prior phase III trials in diabetic CKD. In this study of 14,574 patients with diabetic and non-diabetic CKD, finerenone reduced the risk of kidney failure or CKD progression by 24% versus placebo. Finerenone also reduced the risk of hospitalisation for heart failure or cardiovascular death by 20%, and all-cause death by 12% versus placebo. These effects were consistent regardless of diabetes status, underlying kidney disease, or kidney function.
Associate Professor Brendon Neuen, Lead Global Clinical Trialist at The George Institute, said the findings support finerenone as a foundational therapy for CKD.
“Although diabetes is the single most common cause of chronic kidney disease worldwide, most people living with CKD do not have diabetes and currently have few effective treatment options. Addressing this unmet need is critical, as improving outcomes in non-diabetic CKD has the potential to substantially reduce the global burden of kidney disease.”
Across all three studies, finerenone was generally well tolerated. Hyperkalaemia (high blood potassium levels) occurred more frequently with finerenone compared to placebo, but rates of treatment discontinuation and hospitalisation due to hyperkalemia were low.
CKD affects around one in ten people globally, or approximately 850 million individuals.5 Already a leading cause of death and disability, it is projected to become the fifth largest contributor of premature death by 2040.6 Once CKD progresses to advanced stages, the risks of hospitalisation, cardiovascular events, and death escalate dramatically, underscoring the urgency of early and effective intervention.
A/Prof Neuen said, “Taken together, these findings suggest that expanding the use of finerenone in patients with CKD has the potential to meaningfully reduce kidney failure and cardiovascular complications for millions of people worldwide.”
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References
- Agarwal R, et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J. 2021. https://doi.org/10.1093/eurheartj/ehaa736
- Heerspink HJL, et al. Finerenone in Persons With Chronic Kidney Disease Without Diabetes. NEJM. 2026. https://doi.org/10.1056/NEJMoa2604625
- Neuen BL, et al. Finerenone in Patients with Chronic Kidney Disease Due to Glomerular Diseases. JAMA. 2026. https://doi.org/10.1001/jama.2026.9923
- Neuen BL, et al. Efficacy and safety of finerenone in patients with chronic kidney disease: an individual participant data pooled analysis (INFINITY). Lancet. 2026. https://doi.org/10.1016/S0140-6736(26)01009-3
- Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Iny Suppl. 2022. https://doi.org/10.1016/j.kisu.2021.11.003
- Foreman KJ, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet. 2018. https://doi.org/10.1016/S0140-6736(18)31694-5
Journal
The Lancet
Method of Research
Meta-analysis
Subject of Research
People
Article Title
Efficacy and safety of finerenone in patients with chronic kidney disease: an individual participant data pooled analysis (INFINITY)
Article Publication Date
5-Jun-2026
COI Statement
BLN has received grants for publication support from Menarini (paid directly to George Institute of Global Health); has received consultancy fees from AstraZeneca, Alexion, Bayer, Boehringer and Ingelheim, CSL-Seqirus, Novo Nordisk, Proton Intelligence, Sobi, Travere, Otsuka, and Vera Therapeutics; has received payment or honoraria from AstraZeneca, Boehringer and Ingelheim, Bayer, MJH Life Sciences, Cornerstone Medical Education; has received support for meeting attendance or travel from AstraZeneca, CSL Behring, Novo Nordisk; and is the Deputy Scientific Chair, World Congress of Nephrology 2026. HJLH has received honoraria from Bayer for participation in the FINE-ONE clinical trial steering committee (honoraria paid to employer University of Groningen); received grants from AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, and Novo Nordisk (paid to employer University of Groningen); received consulting fees from AstraZeneca Alexion, Alnylam, Amgen, Bayer, Boehringer Ingelheim, Biocity Biopharmaceuticals, Dimerix, Eli Lilly, Novo Nordisk, Novartis, Roche, and Travere Therapeutics; received speaker fees from AstraZeneca, Bayer, and Novo Nordisk; and received support for attending meetings or travel from AstraZeneca and Eli Lily. VP has received honoraria for steering committee, data monitoring committee, or advisory board roles or for scientific presentations from AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, Cajal Consulting, Emerald Clinical, GlaxoSmithKline, Guard therapeutics, Incyte, Janssen, Mineralys, Novo Nordisk, Novartis, Otsuka, Purespring, Sidera, Sitala, Shanxi Micot, Travere, Tricida, and Vifor; serves on the board of directors for Emerald Clinical, St Vincents Health Australia, Kidney Health Australia, and Mindgardens Neuroscience Network; and has stock in Emerald Clinical. DZIC has received research grants from AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, CSL Behring, Janssen, Merck, Novo Nordisk, and Sanofi; has received consultancy fees from Boehringer Ingelheim/Eli Lilly, Merck, AstraZeneca, Sanofi, Mitsubishi Tanabe, AbbVie, Janssen, Amgen, Bayer, Prometic, Bristol Myers Squibb, Maze, Gilead, CSL-Behring, Otsuka, Novartis, Youngene, Lexicon, Inversago, GlaxoSmithKline, Biobridge, Vantage, Altimmune, and Novo Nordisk; has received payment honoraria from AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, Janssen, Merck, Mitsubishi Tanabe, Novo Nordisk, and Sanofi; has received meeting travel or attendance support from AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lily, Janssen, Merck, and Novo Nordisk; and was in receipt of drug from AstraZeneca. CSPL has received research grants from the National Medical Research Council of Singapore, Novo Nordisk, and Roche Diagnostic; has served in advisory, consulting, and trial leadership roles for Alnylam Pharma, AnaCardio, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Corteria, CPC Clinical Research, Cytokinetics, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Janssen Research & Development, Klyv Therapeutics, Medscape/WebMD Global, Merck, Novartis, Novo Nordisk, Pfizer, Radcliffe Group, Ribocure, Roche, and Us2.ai; has patent PCT/SG2016/050217 pending and patent (US Patent 10,631,828 B1; US 10,702,247 B2; US 11,301,996 B2; US 11,446,009 B2; US 11,931,207 B2; US 12,001,939; US 12,400,762 B2); and is a co-founder and non executive director of Us2.ai. KRT has received grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Heart, Lung, and Blood Institute, National Center for Advancing Translational Sciences, the National institutes of Health Director’s Office, Centers for Disease Control and Prevention, Breakthrough T1D, Benaroya Research Institute, Doris Duke Foundation, Travere, Bayer, and Otsuka (paid directly to institution); has received consulting fees from Alnylam, AstraZeneca, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Novo Nordisk, ProKidney, and Roche; has received speaker fees from AstraZeneca, Bayer, Boehringer Ingelheim,Novo Nordisk, and Travere; has participated in an advisory board for NIDDK, George Clarke Institute, and AstraZeneca; and is a chair at the Diabetic Kidney Disease Collaborative and was a co-chair at American Society of Nephrology Kidney Week 2025 Program Committee. CW has received consultancy fees from Vera Therapeutics and Bayer; has received honoraria from Boehringer Ingelheim and Eli Lilly; participated in Data Safety Monitoring Board or Advisory Board for AstraZeneca, Bayer, GlaxoSmithKline, Novo Nordisk, Sanofi, CSL-Vifor, and Merck. PSa has received honoraria for advisory boards from Astellas, Bayer, Boehringer Ingelheim, Value Research, Vantive, TEVA, Specialty Therapeutics, PRO.MED.CS, F Hoffmann-La Roche, and SOBI; speaker fees from AstraZeneca, Bayer, Genesis Pharma, Boehringer Ingelheim, Winmedica, Vifor Fresenius, and Vantive; research support from AstraZeneca, Boehringer Ingelheim, Genesis Pharma, Vianex, and Menarini; has received meeting travel or attendance support from Bayer, Specialty Therapeutics, and Genesis Pharma; and is a member of trial committees for Bayer, CSL Behring, and Alnylam/F Hoffmann-La Roche. SDA has received research support from Abbott Vascular and Vifor Pharma; has received consultancy fees from AstraZeneca, Berlin Heals, BiMyo, Brahms, Cordio, Corvia, Aytokinetics, Edwards, Novartis, Novo Nordisk, Regeneron, Relaxera, Scirent, Sensible Medical, Vectorious, Veru, and Viscardia; has received honoraria from Actimed Therapeutics, Eli Lily, Mankind Pharma, Reparion, and Vivus; is named co-inventor of two patent applications regarding MR-proANP (DE 102007010834 & DE 102007022367), but does not benefit personally from the related issued patents; and has a leadership or fiduciary role for Alleviant, Amgen, Bayer AG, Boehringer Ingelheim, Cardiac Dimensions, Cardior, CSL-Vifor, CVRx, Impluse Dynamics, Occlutech, Pfizer, Pulnovo and V-Wave. GF reports grants from the European Commission; honoraria from Bayer, Boehringer Ingelheim, Servier, and Novo Nordisk; participates in Data Safety Monitoring or Advisory Board for Bayer, Boehringer Ingelheim, and Novo Nordisk; acts in a leadership or fiduciary role for Heart Failure Association, JACC-Heart Failure, European Journal of Heart Failure; and receives trial committee membership fees from Medtronic, Bayer, Boehringer Ingelheim, Vifor, Amgen, Servier, Impulse Dynamics, Cardior, Merck, AstraZeneca, and Novo Nordisk. BP reports consultant fees from Bayer, Boehringer Ingelheim, Lexicon, AstraZeneca, Vifor, ScPharmaceuticals, SQ innovations, G3 Pharmaceuticals, Sarfez Pharmaceuticals, KBP Biosciences, Cereno Scientific, Brainstorm Medical, Prointel, PhaseBio, Tricida, and Sea Star Medica.; has stock options with G3 Pharmaceuticals, Brainstorm Medical, Proton Intelligence, Tricida, Vifor, ScPharmaceuticals, SQ innovations, Sarfez Phaemaceuticals, KBP Biosciences, and Cereno Scientific; holds a patent for site-specific delivery of eplerenone to the myocardium (US patent 9931412) and a provisional patent for histone acetylation-modulating agents for the treatment and prevention of organ injury (provisional patent US 63/045,784). PR reports sponsorship from Bayer during the conduct of the study; has received research grants from AstraZeneca, Bayer, and Novo Nordisk; has received consultancy fees from Astellas Pharma, Abbott, Amgen, Boehringer Ingelheim, Eli Lilly, Gilead, Mundipharma, Novartis, Roche, Regeneron, Sanofi, and Vifor Pharma; received honoraria from Bayer, Eli Lilly, and Daiichi Sankyo; has received meeting travel or attendance support from Bayer; received study medication from Bayer, AstraZeneca, Lexicon Pharma, and Novo Nordisk; and has financial or non-financial interests with Astellas Pharma, Gilead, Mundipharma, Novartis, Regeneron, Sanofi, and Vifor Pharma; all fees are given to Steno Diabetes Center Copenhagen. LMR reports consultant fees from Bayer. NJ received travel support from AstraZeneca. JDS has no competing interests. MB, CA, AH-B, PSc, TE, RD, and RL are employees of Bayer, Germany, and report ownership interest in Bayer. AL is a full-time employee at Bayer, Brazil, and reports ownership interest in Bayer. RA has received support from Bayer for Steering committee, adjudication committee, publication committee of FIDELIO DKD and FIGARO-DKD, and being a Principal Investigator for FIDELITY analysis; has had ad hoc consultant, speaker, and participation in Advisory Boards; has received consultancy fees from Boehringer Ingelheim, Novartis, Akebia, Intercept Pharma, and Alnylam; has received meeting travel or attendance support from Boehringer Ingelheim, Novartis, Akebia, and Vertex; and participates on a Drug Safety Monitoring or Advisory Board for Vertex, Eloxx, and Chinook.