Inside FIND-CKD: The Data Behind the Trial's 23% Risk Reduction

This is a deep dive into one segment of a recent episode of Kidney Compass: Navigating Clinical Trials, HCPLive's podcast co-hosted by Shikha Wadhwani, MD, and Brendan Neuen, MBBS, PhD. In this episode, Neuen steps out of his usual co-host role to join as a guest, discussing the FIND-CKD trial results he presented at ERA. The full episode also covers the glomerulonephritis subgroup analysis and pooled safety data.

Finerenone reduced the risk of kidney and cardiovascular events by 23% in patients with non-diabetic chronic kidney disease (CKD), according to results from the phase 3 FIND-CKD trial. The effect was driven by a 0.7 mL/min/1.73m² per year improvement in total glomerular filtration rate (GFR) slope that held consistent across every prespecified subgroup investigators examined.

"So, really clear, clear-cut effects on slope, the clinical outcome, as well as a safety profile that was entirely in keeping with what we expected about the drug," Brendan Neuen, MBBS, PhD, told HCPLive.

Primary Endpoint: Total GFR Slope Improvement Matched the Trial's Own Power Calculation

FIND-CKD was powered to detect a 0.7 mL/min/1.73m² per year improvement in total GFR slope with finerenone versus placebo, a figure derived from the treatment effect observed in the earlier FIDELIO-DKD trial. Over 32 months of follow-up, the trial hit that number.

"For the primary outcome of total GFR slope, we saw exactly as we anticipated and powered for, a 0.7 mL per minute per year improvement with finerenone versus placebo over a 32 month follow-up period," Neuen said.

Excluding the acute, treatment-related dip in GFR that occurs shortly after MRA initiation, the effect on chronic slope alone was larger, at 1.2 mL/min/1.73m² per year. Investigators noted this pattern is expected with kidney-protective therapies, where an early hemodynamic drop is followed by a slower rate of long-term decline.

Effect Was Consistent Across Every Prespecified Subgroup

Neuen emphasized that the slope benefit did not vary meaningfully by underlying kidney disease etiology or baseline patient characteristics.

"That effect was entirely consistent regardless of cause of kidney disease, hypertensive, ischemic nephrosclerosis, glomerular diseases, and others," Neuen said. "It was consistent across different levels of kidney function, different levels of albuminuria, and regardless of SGLT2 inhibitor use."

This consistency extended to the trial's glomerulonephritis (GN) subgroup, which made up roughly 60% of the overall cohort, as well as to patients already on background sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy, a group whose representation grew over the course of the trial as standard of care shifted.

Key Secondary Endpoint: 23% Reduction in Kidney-Cardiovascular Composite

Because slope is a surrogate measure, investigators built the trial's key secondary endpoint around outcomes with more direct clinical meaning to patients and clinicians: a composite of a 57% decline in GFR (equivalent to a doubling of serum creatinine), kidney failure, heart failure hospitalization, or cardiovascular death.

"We knew that while slope is important, clinicians, payers, and patients really want to know what is the effect on clinical outcomes and how people feel, function, and survive," Neuen said.

The composite endpoint was reduced by 23% with finerenone versus placebo, a statistically significant result that tracked closely with what the observed slope effect would predict. Investigators also reported an approximately 40% reduction in albuminuria over 12 months and a modest reduction in blood pressure.

Safety: Hyperkalemia More Common, but Discontinuations Remained Rare

As with other agents in the MRA class, hyperkalemia emerged as the primary safety signal. Mean serum potassium increased by approximately 0.12 mmol/L over the course of the trial, and hyperkalemia occurred more frequently with finerenone than placebo (17% vs 13%).

"Hyperkalemia events that led to discontinuation of study treatment were very uncommon overall, at about 1%," Neuen said.

Contextualizing the Effect Size: How Finerenone Compares to SGLT2 Inhibitors

For clinicians unfamiliar with GFR slope as a trial endpoint, Neuen offered a direct comparison to a more familiar drug class. The 0.7 mL/min/1.73m² per year effect observed with finerenone compares to a roughly 0.5 to 0.6 mL/min/1.73m² per year effect on total slope observed with SGLT2 inhibitors in the DAPA-CKD and EMPA-KIDNEY trials, both of which also enrolled patients with non-diabetic CKD.

"These effects are at least comparable to the SGLT2 inhibitor class, and suggest a role for combination treatment in non-diabetic kidney disease in the future," Neuen said.

Clinical Implications

Until now, patients with non-diabetic CKD have had access to only SGLT2 inhibitors on top of renin-angiotensin system (RAS) inhibition, a narrower toolkit than the four-pillar regimen (RAS inhibitors, SGLT2 inhibitors, nonsteroidal MRAs, and GLP-1 receptor agonists) established for diabetic kidney disease. The consistency of benefit across kidney function levels, albuminuria levels, and SGLT2 inhibitor exposure suggests finerenone could be layered onto existing background therapy rather than positioned as a replacement for it, an approach Neuen and colleagues plan to characterize further in subgroup-specific analyses, including in the trial's GN population.

Editors' Note: Disclosures for Wadhwani include Boehringer Ingelheim, Calliditas Therapeutics, GSK, Otsuka Pharmaceutical Co., Travere Therapeutics, and others. Disclosures for Neuen include AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, and others.

References

1. Heerspink HJL, Neuen BL, Agarwal R, et al. Finerenone in persons with chronic kidney disease without diabetes. N Engl J Med. 2026. doi:10.1056/NEJMoa2604625

2. Finerenone slows kidney function decline and reduces cardiovascular-kidney risk in non-diabetic chronic kidney disease, major trial shows [press release]. European Renal Association. Published June 4, 2026.

3. Heerspink HJL, Tuttle KR, Perkovic V. Finerenone in patients with chronic kidney disease. Presented at: 63rd ERA Congress; June 3-6, 2026; Glasgow, Scotland. Abstract 186.