---
title: "Finerenone Slows eGFR Decline in Chronic Kidney Disease Patients Without Diabetes"
id: "pubmed-42246672"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42246672"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42246672/"
doi: "10.1056/NEJMoa2604625"
published_at: "2026-08-06T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Finerenone Slows eGFR Decline in Chronic Kidney Disease Patients Without Diabetes
## Provenance & Clinical Metadata
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- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42246672/)
- **DOI:** [10.1056/NEJMoa2604625](https://doi.org/10.1056%2FNEJMoa2604625)
- **Published At:** 2026-08-06T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This randomized, multicenter trial evaluated **finerenone**, a nonsteroidal mineralocorticoid receptor antagonist, in adults with **chronic kidney disease (CKD)** who did not have diabetes. - Eligibility included estimated glomerular filtration rate (**eGFR**) 25 to <90 ml/min/1.73 m2, urinary albumin-to-creatinine ratio 200 to ≤3500 mg/g, and background use of a renin–angiotensin system inhibitor. - 1,584 participants were randomized: 793 to finerenone (10 or 20 mg daily) and 791 to placebo. Baseline mean eGFR was ~46.7 ml/min/1.73 m2 in both groups. - The primary outcome was the total eGFR slope (mean annual rate of change to month 32), analyzed with a two-slope linear spline mixed-effects model. - Mean annual eGFR decline was -3.3 ml/min/1.73 m2 with finerenone versus -4.0 ml/min/1.73 m2 with placebo (difference 0.7; 95% CI, 0.3 to 1.1; P<0.001). - Prespecified hierarchical testing showed a lower risk of a composite kidney or cardiovascular outcome with finerenone (hazard ratio 0.77; 95% CI, 0.60 to 0.99; P = 0.04). - Hazard ratios were 0.78 (95% CI, 0.60 to 1.01) for the kidney composite and 0.60 (95% CI, 0.27 to 1.33) for the cardiovascular composite; confidence intervals for these secondaries crossed 1.0. - The most common adverse event was **hyperkalemia**: 17.0% with finerenone vs. 13.3% with placebo. Hyperkalemia led to treatment discontinuation in 1.5% vs. 0.1% and to hospitalization in 0.9% vs. 0.6%, respectively. - The trial authors conclude that finerenone slowed eGFR decline over 32 months in adults with CKD without diabetes. - Funding was provided by Bayer; the ClinicalTrials.gov identifier is NCT05047263. - Details not reported in the abstract (for example, subgroup analyses, full adverse-event profile, and longer-term follow-up beyond month 32) are not available in the provided source extract.
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Epub 2026 Jun 4. # Finerenone in Persons with Chronic Kidney Disease without Diabetes [Hiddo J L Heerspink](https://pubmed.ncbi.nlm.nih.gov/?term=Heerspink+HJL&cauthor_id=42246672)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-1 "George Institute for Global Health, University of New South Wales, Sydney.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-2 "Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands."), [Brendon L Neuen](https://pubmed.ncbi.nlm.nih.gov/?term=Neuen+BL&cauthor_id=42246672)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-1 "George Institute for Global Health, University of New South Wales, Sydney.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-3 "Department of Renal Medicine, Royal North Shore Hospital, Sydney."), [Rajiv Agarwal](https://pubmed.ncbi.nlm.nih.gov/?term=Agarwal+R&cauthor_id=42246672)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-4 "Division of Nephrology, Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis."), [David Z I Cherney](https://pubmed.ncbi.nlm.nih.gov/?term=Cherney+DZI&cauthor_id=42246672)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-5 "Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, Toronto."), [Carolyn S P Lam](https://pubmed.ncbi.nlm.nih.gov/?term=Lam+CSP&cauthor_id=42246672)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-6 "National Heart Centre Singapore, Singapore.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-7 "Duke-National University of Singapore Medical School, Singapore."), [Katherine R Tuttle](https://pubmed.ncbi.nlm.nih.gov/?term=Tuttle+KR&cauthor_id=42246672)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-8 "Providence Inland Northwest Health, University of Washington School of Medicine, Spokane."), [Christoph Wanner](https://pubmed.ncbi.nlm.nih.gov/?term=Wanner+C&cauthor_id=42246672)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-9 "Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany."), [Pantelis Sarafidis](https://pubmed.ncbi.nlm.nih.gov/?term=Sarafidis+P&cauthor_id=42246672)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-10 "First Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece."), [Niels Jongs](https://pubmed.ncbi.nlm.nih.gov/?term=Jongs+N&cauthor_id=42246672)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-2 "Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands."), [J David Smeijer](https://pubmed.ncbi.nlm.nih.gov/?term=Smeijer+JD&cauthor_id=42246672)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-2 "Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands."), [Meike Brinker](https://pubmed.ncbi.nlm.nih.gov/?term=Brinker+M&cauthor_id=42246672)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-11 "Cardiology and Nephrology Clinical Development, Bayer, Wuppertal, Germany."), [Nicole Rethemeier](https://pubmed.ncbi.nlm.nih.gov/?term=Rethemeier+N&cauthor_id=42246672)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-12 "Clinical Statistics and Analytics, Bayer, Wuppertal, Germany."), [Patrick Schloemer](https://pubmed.ncbi.nlm.nih.gov/?term=Schloemer+P&cauthor_id=42246672)[ 13 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-13 "Clinical Statistics and Analytics, Bayer, Berlin."), [Paula Vesterinen](https://pubmed.ncbi.nlm.nih.gov/?term=Vesterinen+P&cauthor_id=42246672)[ 14 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-14 "Medical and Scientific Affairs, Bayer, Espoo, Finland."), [David Goldsbury](https://pubmed.ncbi.nlm.nih.gov/?term=Goldsbury+D&cauthor_id=42246672)[ 15 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-15 "Bayer, Reading, United Kingdom."), [Sara Dizayee](https://pubmed.ncbi.nlm.nih.gov/?term=Dizayee+S&cauthor_id=42246672)[ 16 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-16 "Regulatory Strategy Cardiology and Nephrology, Bayer, Wuppertal, Germany."), [Jon W Mares](https://pubmed.ncbi.nlm.nih.gov/?term=Mares+JW&cauthor_id=42246672)[ 17 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-17 "Bayer US Medical Affairs, Whippany, NJ."), [Vlado Perkovic](https://pubmed.ncbi.nlm.nih.gov/?term=Perkovic+V&cauthor_id=42246672)[ 18 ](https://pubmed.ncbi.nlm.nih.gov/42246672/#full-view-affiliation-18 "University of New South Wales, Sydney."); [FIND-CKD Investigators](https://pubmed.ncbi.nlm.nih.gov/?term=FIND-CKD+Investigators%5BCorporate+Author%5D) Collaborators, Affiliations Expand * PMID: **42246672** * DOI: [ 10.1056/NEJMoa2604625 ](https://doi.org/10.1056/nejmoa2604625) Item in Clipboard Randomized Controlled Trial # Finerenone in Persons with Chronic Kidney Disease without Diabetes Hiddo J L Heerspink et al. N Engl J Med. 2026. Show details Display options Display options Format Abstract PubMed PMID N Engl J Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22N+Engl+J+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22N+Engl+J+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42246672/) . 2026 Aug 6;395(6):533-545. doi: 10.1056/NEJMoa2604625. Epub 2026 Jun 4. * PMID: **42246672** * DOI: [ 10.1056/NEJMoa2604625 ](https://doi.org/10.1056/nejmoa2604625) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** In randomized trials, finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improved kidney and cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease (CKD). Whether finerenone has similar effects in patients without diabetes who have CKD is unknown. **Methods:** We randomly assigned adults without diabetes who had CKD (estimated glomerular filtration rate [eGFR], 25 to <90 ml per minute per 1.73 m2 of body-surface area) and albuminuria (urinary albumin-to-creatinine ratio, 200 to ≤3500, with albumin in milligrams and creatinine in grams) and were using a renin-angiotensin system inhibitor to receive finerenone (10 or 20 mg daily) or placebo. The primary outcome was the total eGFR slope (mean annual rate of change in the eGFR from baseline to month 32), assessed with a two-slope linear spline mixed-effects model. Secondary outcomes included a composite of kidney or cardiovascular events (reduction from baseline of at least 57% in the eGFR, kidney failure, hospitalization for heart failure, or death from cardiovascular causes), a composite of the two kidney events, and a composite of the two cardiovascular events. **Results:** A total of 1584 participants underwent randomization - 793 were assigned to the finerenone group, and 791 to the placebo group. The mean (±SD) baseline eGFR was 46.8±16.2 ml per minute per 1.73 m2 with finerenone and 46.6±16.0 ml per minute per 1.73 m2 with placebo. The mean annual rate of change in the eGFR from baseline to month 32 was -3.3 ml per minute per 1.73 m2 (95% confidence interval [CI], -3.6 to -3.1) with finerenone and -4.0 ml per minute per 1.73 m2 (95% CI, -4.3 to -3.8) with placebo (difference, 0.7; 95% CI, 0.3 to 1.1; P<0.001). Prespecified hierarchical testing showed that the risk of a composite kidney or cardiovascular outcome event was lower with finerenone than with placebo (hazard ratio, 0.77; 95% CI, 0.60 to 0.99; P = 0.04); the hazard ratio was 0.78 (95% CI, 0.60 to 1.01) for the composite of the two kidney events and 0.60 (95% CI, 0.27 to 1.33) for the composite of the two cardiovascular events. The most common adverse event was hyperkalemia (135 participants [17.0%] with finerenone and 105 [13.3%] with placebo); hyperkalemia events led to discontinuation of the trial regimen in 12 participants (1.5%) and 1 participant (0.1%), respectively, and to hospitalization in 7 (0.9%) and 5 (0.6%). **Conclusions:** Among adults with CKD who did not have diabetes, finerenone led to a slower decrease in the eGFR than placebo over 32 months. (Funded by Bayer; FIND-CKD ClinicalTrials.gov number, [NCT05047263](http://clinicaltrials.gov/show/NCT05047263 "See in ClinicalTrials.gov").). Copyright © 2026 Massachusetts Medical Society. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. ](https://pubmed.ncbi.nlm.nih.gov/33264825/) Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, Kolkhof P, Nowack C, Schloemer P, Joseph A, Filippatos G; FIDELIO-DKD Investigators.Bakris GL, et al.N Engl J Med. 2020 Dec 3;383(23):2219-2229. doi: 10.1056/NEJMoa2025845. Epub 2020 Oct 23.N Engl J Med. 2020.PMID: 33264825Clinical Trial. * [ Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. ](https://pubmed.ncbi.nlm.nih.gov/38785209/) Perkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, Baeres FMM, Idorn T, Bosch-Traberg H, Lausvig NL, Pratley R; FLOW Trial Committees and Investigators.Perkovic V, et al.N Engl J Med. 2024 Jul 11;391(2):109-121. doi: 10.1056/NEJMoa2403347. Epub 2024 May 24.N Engl J Med. 2024.PMID: 38785209Clinical Trial. * [ Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes. ](https://pubmed.ncbi.nlm.nih.gov/40470996/) Agarwal R, Green JB, Heerspink HJL, Mann JFE, McGill JB, Mottl AK, Rosenstock J, Rossing P, Vaduganathan M, Brinker M, Edfors R, Li N, Scheerer MF, Scott C, Nangaku M; CONFIDENCE Investigators.Agarwal R, et al.N Engl J Med. 2025 Aug 7;393(6):533-543. doi: 10.1056/NEJMoa2410659. Epub 2025 Jun 5.N Engl J Med. 2025.PMID: 40470996Clinical Trial. * [ Efficacy and safety of finerenone in patients with chronic kidney disease: an individual participant data pooled analysis (INFINITY). ](https://pubmed.ncbi.nlm.nih.gov/42248158/) Neuen BL, Heerspink HJL, Perkovic V, Cherney DZI, Lam CSP, Tuttle KR, Wanner C, Sarafidis P, Anker SD, Filippatos G, Pitt B, Rossing P, Ruilope LM, Jongs N, Smeijer JD, Brinker M, Ahlers C, Lage A, Horvat-Bröcker A, Schloemer P, Eissing T, Dayoub R, Lawatscheck R, Agarwal R; FIND-CKD, FIDELIO-DKD and FIGARO-DKD Investigators.Neuen BL, et al.Lancet. 2026 Jun 13;407(10546):2375-2386. doi: 10.1016/S0140-6736(26)01009-3. Epub 2026 Jun 5.Lancet. 2026.PMID: 42248158 * [ Glucagon-like peptide 1 (GLP-1) receptor agonists for people with chronic kidney disease and diabetes. ](https://pubmed.ncbi.nlm.nih.gov/39963952/) Natale P, Green SC, Tunnicliffe DJ, Pellegrino G, Toyama T, Strippoli GF.Natale P, et al.Cochrane Database Syst Rev. 2025 Feb 18;2(2):CD015849. doi: 10.1002/14651858.CD015849.pub2.Cochrane Database Syst Rev. 2025.PMID: 39963952Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42246672) ## Cited by * [ Benefits of finerenone treatment across chronic kidney disease aetiologies. ](https://pubmed.ncbi.nlm.nih.gov/42343109/) Wang M.Wang M.Nat Rev Nephrol. 2026 Aug;22(8):521. doi: 10.1038/s41581-026-01098-6.Nat Rev Nephrol. 2026.PMID: 42343109No abstract available. ## Publication types * Randomized Controlled Trial Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Randomized+Controlled+Trial%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Randomized+Controlled+Trial) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42246672/) * Multicenter Study Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Multicenter+Study%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Multicenter+Study) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42246672/) ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42246672/) * Albuminuria / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Albuminuria%2Fdrug+therapy%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Albuminuria) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42246672/) * Cardiovascular Diseases / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cardiovascular+Diseases%2Fepidemiology%22%5BMeSH%5D&sort=date&sort
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