Finerenone Meets Primary End Point in Nondiabetic Chronic Kidney Disease Trial

The phase 3 FIND-CKD (NCT05047263) trial investigating finerenone (Kerendia; Bayer) in adults with nondiabetic chronic kidney disease (CKD) met its primary end point, demonstrating a statistically significant improvement vs placebo in estimated glomerular filtration rate (eGFR) slope from baseline to month 32, according to a news release from Bayer.¹

This marks the fifth consecutive phase 3 trial in which finerenone met its primary end point and represents the largest phase 3 study to date focused on nondiabetic CKD.¹

“Patients with CKD have substantial risk for cardiovascular events and kidney failure, so new treatments are needed to help slow kidney disease progression and improve outcomes,” Hiddo L. Heerspink, professor of clinical trials and personalized medicine and clinical trialist at the Department of Clinical Pharmacy and Pharmacology at the University Medical Center Groningen, Netherlands, said in the news release.¹

“The FIND-CKD top-line results are encouraging because they now provide evidence for finerenone in a nondiabetic CKD population, on top of its established evidence in diabetic CKD,” Heerspink continued.¹

Trial Design and Patient Population

FIND-CKD enrolled more than 1500 patients with nondiabetic CKD across various etiologies, including hypertension and chronic glomerulonephritis. Patients were randomly assigned to receive either finerenone 10 mg or 20 mg, based on serum potassium levels and eGFR, or placebo. All participants received individually tolerated maximum labeled doses of renin-angiotensin system (RAS)–blocking therapy, such as an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. The primary end point was the mean annual rate of change in eGFR from baseline to 32 months, a validated surrogate end point for kidney disease progression. The safety profile of finerenone in FIND-CKD was consistent with its established safety profile.¹

Nondiabetic CKD affects more than half of the approximately 850 million people worldwide living with CKD. In the United States, more than 35 million people are estimated to have CKD. Common causes of nondiabetic CKD include hypertension and various forms of glomerulonephritis, such as IgA nephropathy, focal segmental glomerulosclerosis, and membranous nephropathy.^1-3

Mechanism of Action and Clinical Evidence

Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that selectively and potently blocks mineralocorticoid receptor overactivation in the heart and kidneys. Overactivation of the mineralocorticoid receptor in CKD increases inflammation and fibrosis through pathways that promote progressive kidney and cardiovascular dysfunction. Unlike steroidal mineralocorticoid receptor antagonists such as spironolactone and eplerenone, finerenone displays distinct effects on cofactor recruitment following receptor binding, resulting in more potent inhibition of inflammatory and fibrotic pathways while causing less potassium retention.^4-6

Finerenone was initially approved by the FDA in 2021 to reduce the risk of cardiovascular death, hospitalization for heart failure, nonfatal myocardial infarction, sustained eGFR decline, and end-stage kidney disease in adult patients with CKD associated with type 2 diabetes. In July 2025, finerenone also received FDA approval for the treatment of heart failure with left ventricular ejection fraction of 40% or higher.¹

The FIND-CKD results now provide evidence for finerenone in a nondiabetic CKD population, adding to its established evidence in diabetic CKD. Bayer anticipates submitting the data to the FDA to extend the indication of finerenone to patients with nondiabetic CKD.¹

Implications for Pharmacists

Pharmacists should be prepared for potential label expansion of finerenone to include nondiabetic CKD. Patient counseling will need to emphasize the importance of adherence to therapy, as finerenone addresses underlying pathophysiologic mechanisms of kidney disease progression rather than providing symptomatic relief.

Hyperkalemia remains the primary safety concern with finerenone therapy. Pharmacists should ensure that serum potassium and eGFR are measured before initiating treatment and monitored periodically during therapy. Patients should be counseled to avoid potassium supplements and salt substitutes containing potassium unless specifically directed by their prescriber. More frequent monitoring may be necessary for patients on concomitant medications that impair potassium excretion or increase serum potassium levels, such as potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, or additional RAS inhibitors.

Pharmacists should also review for potential drug interactions, particularly with cytochrome P450 3A4 inhibitors and inducers. Concomitant use with strong CYP3A4 inhibitors is contraindicated, and patients should be advised to avoid grapefruit and grapefruit juice. When moderate or weak CYP3A4 inhibitors are coadministered, serum potassium should be monitored during drug initiation or dosage adjustment, with finerenone dosage adjusted as appropriate.

REFERENCES

1. Kerendia (finerenone) meets primary endpoint in investigational phase III FIND-CKD study in patients with non-diabetic chronic kidney disease. News release. Bayer. March 16, 2026. Accessed March 17, 2026. https://www.bayer.com/en/us/news-stories/kerendiar-meets-primary-endpoint

2. Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019;96(5):1048-1050. doi:10.1016/j.kint.2019.07.012

3. Chronic kidney disease (CKD). National Kidney Foundation. Updated September 11, 2023. Accessed March 17, 2026. https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd

4. Bakris GL, Agarwal R, Anker SD, et al; FIDELIO-DKD Investigators. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383(23):2219-2229. doi:10.1056/NEJMoa2025845

5. Lerma EV, Wilson DJ. Finerenone: a mineralocorticoid receptor antagonist for the treatment of chronic kidney disease associated with type 2 diabetes. Expert Rev Clin Pharmacol. 2022;15(5):501-513. doi:10.1080/17512433.2022.2094770

6. Agarwal R, Kolkhof P, Bakris G, et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J. 2021;42(2):152-161. doi:10.1093/eurheartj/ehaa736