Expanding the Role of Finerenone in CKD Care, With Brendon Neuen, MBBS, PhD

New findings from the FIND-CKD trial suggest Bayer’s finerenone (Kerendia) may have a broader role in chronic kidney disease (CKD) than previously established, extending benefits beyond patients with diabetes and into a wider range of non-diabetic kidney diseases.

The phase 3 trial met its primary endpoint for statistically significant improvement in eGFR slope versus placebo over 32 months in adult patients with nondiabetic CKD. Bayer described plans to use these data to support a label expansion into this patient population.

Finerenone first received FDA approval in 2021 for adults with CKD associated with type 2 diabetes based on findings from the FIDELIO-DKD and FIGARO-DKD trials, which established the agent's ability to reduce risk of cardiovascular death, hospitalization for heart failure, non-fatal myocardial infarction, sustained eGFR decline, and end-stage kidney disease in patients with diabetic kidney disease. It was later approved for heart failure with left ventricular ejection fraction of 40% or higher in July 2025 and is additionally seeking regulatory approval for patients with type 1 diabetes and CKD based on data from the FINE-ONE trial.

The randomized, double-blind, placebo-controlled, phase 3 FIND-CKD study enrolled more than 1500 adults with non-diabetic CKD, including patients with hypertension-related disease and chronic glomerulonephritis. Results showed finerenone demonstrated superiority over placebo in slowing kidney function decline, meeting its primary endpoint based on total eGFR slope over 32 months.

“What this suggests, and we'll have to look at the data carefully, is that finerenone is likely to play an important role in reducing the risk of kidney disease progression in a much broader range of patients than it is currently being used for,” Brendon Neuen, MBBS, PhD, told HCPLive.

The implications extend beyond a single therapy. As evidence accumulates, the traditional “4 pillars” of CKD management initially established in diabetic kidney disease are increasingly being applied across the CKD spectrum. This includes renin-angiotensin system inhibitors, SGLT2 inhibitors, and now nonsteroidal mineralocorticoid receptor antagonists like finerenone.

For clinicians, this shift underscores the urgency of earlier detection. With more therapies capable of altering disease trajectory, Neuen says timely screening and diagnosis are becoming more critical than ever.

“There is an urgency like we haven't had before to identify people early, screen people for kidney disease, diagnose them appropriately, and treat them with evidence-based therapies,” he said.

At the same time, treatment strategies are evolving toward a multimodal approach, with multiple therapies now available to reduce kidney and cardiovascular complications. Because kidney disease progression is complex and involves many drivers, experts are increasingly recognizing that many patients will require treatment with multiple highly effective therapies. According to Neuen, finerenone is likely to be an important part of that armamentarium.

Looking ahead, Neuen highlighted the importance of precision medicine using validated risk tools to better identify patients who would benefit from intensified therapy and the continued development of targeted treatments, particularly for glomerular diseases. Together, these advances signal a shift toward more individualized, mechanism-based care in CKD.

Editors’ Note: Relevant disclosures for Neuen include AstraZeneca, Bayer, Boehringer and Ingelheim, Janssen, and others.

References

1. Campbell P. Finerenone Proves CKD Benefit Extends Beyond Diabetes in FIND-CKD. HCPLive. March 16, 2026. Accessed March 18, 2026. https://www.hcplive.com/view/finerenone-proves-ckd-benefit-extends-beyond-diabetes-in-find-ckd

2. Campbell P. FINE-ONE: Finerenone Proves Benefit in Type 1 Diabetes and CKD. HCPLive. November 6, 2025. Accessed March 18, 2026. https://www.hcplive.com/view/fine-one-finerenone-proves-benefit-in-type-1-diabetes-and-ckd