A drug already approved to protect kidney function in diabetic patients may work for millions more people, according to major research presented at the European Renal Association Congress in Glasgow and published simultaneously across three elite medical journals.
Finerenone, a non-steroidal mineralocorticoid receptor antagonist, demonstrated significant protective effects in people with chronic kidney disease who do not have diabetes, as well as in patients with specific types of glomerular disease. The findings expand the potential use of the medication well beyond its current approved population.
The scale of publication was itself remarkable. Having a single clinical trial appear in all three journals, The Lancet, The New England Journal of Medicine, and JAMA, simultaneously is an uncommon achievement in medical research.
Benefits Across Multiple Patient Groups
The FIND-CKD trial, which enrolled 1,584 people with non-diabetic chronic kidney disease across 24 countries, found that finerenone slowed the decline in kidney function more effectively than standard treatment alone. Patients taking the drug experienced a 23% reduction in the combined risk of kidney failure, worsening disease, heart failure, or cardiovascular death.
In a separate analysis of patients with glomerular disease, which involves immune-related damage to kidney structures, finerenone lowered the risk of kidney failure or disease progression by 26%. The drug also reduced albuminuria, a measure of protein in the urine and a key marker of kidney damage, by 42% after 12 months.
A third study pooled data from 14,574 participants across multiple trials to compare outcomes in both diabetic and non-diabetic kidney disease. Finerenone reduced the risk of kidney failure or disease progression by 24%, lowered the risk of hospitalization for heart failure or cardiovascular death by 20%, and cut the risk of death from any cause by 12%.
Researchers noted that these benefits remained consistent regardless of whether patients had diabetes, the type of kidney disease they had, or their level of kidney function at the start of treatment.
The mechanism behind finerenone's effectiveness lies in its action on the mineralocorticoid receptor. Excessive activation of this receptor contributes to inflammation and scarring in many kidney disorders, not just those related to diabetes.
The main side effect of concern was elevated blood potassium levels, which occurred more frequently in patients taking finerenone than in those on placebo. However, treatment discontinuation and hospitalizations related to high potassium were uncommon.
Chronic kidney disease affects roughly one in ten people worldwide, approximately 850 million individuals. The condition is already a major cause of illness and death and is projected to become the fifth leading cause of premature death globally by 2040. Most people with chronic kidney disease do not have diabetes but currently have few effective treatment options.
Expanding finerenone use could meaningfully reduce kidney failure and cardiovascular complications across millions of patients, according to researchers involved in the trials. The findings suggest the drug should be considered a foundational therapy for chronic kidney disease more broadly.
Author Jessica Williams: "These results blow open what we thought finerenone could do, moving it from a diabetes-specific drug to a potential game changer for most chronic kidney disease patients."
Comments