A drug approved for one type of kidney disease just proved it can slow the progression of an entirely different form of the condition – in a trial larger than any previously run in that patient population. The drug is finerenone, sold under the brand name Kerendia, and the patients in question are the millions living with chronic kidney disease who don’t have diabetes. Until now, they had no approved therapy specifically targeting the biological mechanisms that drive their kidney decline.
Kidney disease is relentlessly common. CKD affects an estimated 850 million people worldwide and remains a major cause of illness and death. Although diabetes is a leading contributor, many patients develop the condition in its absence and continue to face a substantial risk of progressive kidney function loss, kidney failure, and cardiovascular complications despite current standard therapies. For those patients, the standard toolkit has been frustratingly thin – blood pressure medications, dietary restriction, and watchful waiting. Finerenone may be about to change that calculation entirely.
The results that landed in June 2026 – published simultaneously in the New England Journal of Medicine and presented at the European Renal Association Congress in Glasgow – represent the first time a mineralocorticoid receptor antagonist has demonstrated this kind of kidney drug treatment benefit beyond diabetic kidney disease.
What Finerenone Is and How It Works as a Kidney Drug Treatment
Finerenone is a nonsteroidal mineralocorticoid receptor antagonist (MRA) – a drug that blocks a specific hormone receptor involved in kidney inflammation and scarring. The FIND-CKD results now provide evidence for its use in a non-diabetic CKD population, adding to its established evidence in diabetic CKD. Bayer, the drug’s manufacturer, anticipates submitting the data to the FDA to extend the indication to patients with non-diabetic CKD. Patient counseling will need to emphasize the importance of adherence to therapy, as finerenone addresses underlying disease mechanisms rather than merely managing symptoms.
Aldosterone is a hormone that, when overactivated, triggers inflammation and scarring in kidney tissue and heart muscle. By blocking aldosterone’s binding to the mineralocorticoid receptor, MRAs reduce these downstream effects, thereby reducing fluid retention, lowering blood pressure, and protecting against organ damage in conditions like CKD and heart failure.
What sets finerenone apart from older drugs in the same class, like spironolactone and eplerenone, is precision. Finerenone has demonstrated greater receptor selectivity and fewer side effects compared to older mineralocorticoid receptor antagonists. Historically, steroidal MRAs like spironolactone and eplerenone have been used in the management of heart failure and hypertension, but finerenone, as a non-steroidal MRA, has demonstrated greater selectivity and fewer side effects, with multiple clinical trials supporting its use across the cardiovascular-kidney-metabolic spectrum. At the molecular level, research published in the American Journal of Hypertension explains that finerenone acts as a receptor antagonist that inhibits transcriptional cofactor recruitment – the process that switches on genes responsible for inflammation and tissue scarring in the kidney.
The FIDELIO-DKD Trial: What It Proved in Diabetic Kidney Disease
The first major chapter in finerenone’s clinical story was the FIDELIO-DKD trial, which enrolled patients with CKD associated with type 2 diabetes. The results established the drug’s credentials as a genuine kidney-protective therapy, not just a blood pressure pill with kidney-adjacent benefits.
In the FIDELIO-DKD trial, finerenone reduced the primary composite kidney outcome – which included kidney function decline, kidney failure, and kidney-related death – by 18% compared to placebo. The same trial found finerenone reduced the key secondary composite cardiovascular outcome by 14% compared to placebo. Those are clinically meaningful numbers in a disease where most treatments only modestly slow decline. According to a 2024 review in Frontiers in Medicine, both the kidney and cardiovascular benefits were statistically robust and consistent across patient subgroups.
The FDA approved finerenone in July 2021 to reduce the risk of kidney function decline, kidney failure, cardiovascular death, and heart failure hospitalization in adults with CKD associated with type 2 diabetes. That approval – under the brand name Kerendia – gave nephrologists and endocrinologists a new tool for one of the most common and damaging complications of diabetes. For anyone managing both type 2 diabetes and early signs of kidney disease, finerenone is now a guideline-supported option.
The FIND-CKD Trial: Breaking Through to Non-Diabetic Patients
The FIND-CKD trial is the largest Phase III trial ever conducted in patients with non-diabetic CKD. The patient population was deliberately broad: the study enrolled more than 1,500 participants with a range of underlying kidney diseases, including hypertension-associated kidney disease.
The Phase III FIND-CKD study met its primary endpoint, demonstrating a statistically significant improvement versus placebo in the primary efficacy outcome of eGFR slope (estimated glomerular filtration rate, the standard measure of kidney function), defined as the mean annual rate of change from baseline to month 32. In plain terms, patients taking finerenone lost kidney function at a measurably slower rate over nearly three years. The safety profile in FIND-CKD was consistent with finerenone’s established safety profile from prior trials.
The secondary outcomes were equally striking. According to findings presented at the 63rd ERA Congress in Glasgow, Scotland, finerenone significantly slowed kidney function decline and reduced the risk of cardiovascular-kidney outcomes in adults with non-diabetic CKD. A 2026 report from EMJ Reviews noted that finerenone achieved a key secondary endpoint by reducing the risk of a composite cardiovascular-kidney outcome by 23% versus placebo – a composite that included kidney failure, significant drops in eGFR, hospitalization for heart failure, and cardiovascular death.
Expanding Approvals: Type 1 Diabetes and Heart Failure
The non-diabetic CKD data is the most recent development, but finerenone has been quietly expanding its territory across multiple conditions. In July 2025, finerenone received FDA approval for the treatment of heart failure with left ventricular ejection fraction of 40% or higher – a form of heart failure, often called heart failure with preserved ejection fraction, where the heart pumps strongly but has become too stiff to fill properly. That approval was based on the FINEARTS-HF trial. In 2024, the FINEARTS-HF trial showed that finerenone reduced the risk of the primary composite outcome of cardiovascular death and total heart failure events in patients with heart failure with mid-range ejection fraction and preserved ejection fraction.
Type 1 diabetes is another frontier. Approximately 20% to 30% of people in the US with type 1 diabetes also have CKD, placing them at serious risk of both kidney failure and cardiovascular events, yet they were explicitly excluded from the original FIDELIO-DKD approval. The FINE-ONE trial addressed that gap. In the FINE-ONE trial, finerenone reduced urinary albumin-to-creatinine ratio – a key marker of kidney damage – by approximately 25% compared to placebo at six months. Reduced albumin in the urine signals that the kidney’s filtering membranes are under less stress. The FDA accepted Bayer’s supplemental New Drug Application and granted Priority Review designation for finerenone in CKD associated with type 1 diabetes in May 2026.
5. The Main Risk: Hyperkalemia
Finerenone carries one risk that consistently stands out across its trial data: hyperkalemia, which is an elevated level of potassium in the blood. The kidneys normally filter excess potassium out of the body, so when they’re impaired, potassium can build up – and drugs that affect aldosterone (the hormone that regulates potassium excretion) can compound that problem.
In the FIND-CKD trial, the most common adverse event was hyperkalemia, occurring in 17.0% of finerenone participants versus 13.3% with placebo. In the FIDELIO-DKD trial of diabetic patients, the gap was wider: hyperkalemia-related adverse events occurred in 18.3% of patients taking finerenone versus 9.0% on placebo. Hyperkalemia at mild levels often produces no symptoms at all, which is why blood tests are essential. At higher levels, potassium buildup can cause muscle weakness, irregular heartbeat, and – in severe cases – life-threatening cardiac arrhythmias.
Independent risk factors for hyperkalemia in finerenone users include higher baseline serum potassium, lower eGFR, increased urine albumin-creatinine ratio, younger age, female sex, and beta-blocker use. One practical offset: diuretic or SGLT2 inhibitor use reduced hyperkalemia risk in trial data, suggesting that patients already on these drug classes may have a degree of natural protection. For context, finerenone produces a relatively modest mean increase in serum potassium of approximately 0.18 mEq/L, roughly one-third less than that seen with spironolactone or aldosterone synthase inhibitors.
What to Do If You Experience Hyperkalemia Symptoms
If you’re taking finerenone and notice muscle weakness, fatigue that feels different from your usual, or an irregular heartbeat, treat these as signals to contact your doctor promptly rather than waiting for your next scheduled visit. Hyperkalemia rarely presents dramatically, but the symptoms above are the warning signs that potassium may be rising to a level that warrants action.
Routine potassium monitoring, with temporary treatment interruption and dose reduction in the event of hyperkalemia, is necessary for the safe use of finerenone to protect the kidneys and cardiovascular system of patients with CKD. In clinical trials, the protocol was structured: serum potassium levels guided drug dosing during the study. Patients in either group who experienced mild or greater hyperkalemia had the study drug withheld until serum potassium returned to 5.0 mmol/L or below, then the drug was restarted.
Get a serum potassium blood test before starting finerenone, again within four weeks of starting or changing dose, and periodically thereafter as your doctor recommends. The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guideline for CKD lists finerenone as an add-on therapy for patients already optimized on an ACE inhibitor or ARB therapy, and notes it carries a reduced risk of hyperkalemia compared with spironolactone. Patients should also minimize high-potassium foods – bananas, oranges, potatoes, and tomatoes in large quantities – while on the drug, and flag any potassium supplements to their prescribing physician.
Why Doctors Were Slow to Prescribe It – and Why That’s Changing
Despite a July 2021 FDA approval, prescriptions for finerenone remained strikingly low for years. In 2024, finerenone prescriptions totaled less than 3% of those for empagliflozin – a competing drug used in many of the same patients. That gap isn’t easily explained by evidence alone.
Several forces drove that hesitancy. Finerenone’s newer status and lack of head-to-head trials with other MRAs contributed to clinical inertia – the tendency for physicians to continue with familiar prescribing patterns rather than adopt newer agents. Compared to SGLT2 inhibitors, which arrived with broader indications, stronger Class 1 guideline recommendations in the US, and earlier market entry, finerenone saw lower adoption despite overlapping therapeutic goals. In the US, SGLT2 inhibitors like empagliflozin carry a Class 1A recommendation from KDIGO, while finerenone holds a Class 2A recommendation for patients with type 2 diabetes, eGFR of at least 25 mL/min per 1.73 m², normal serum potassium, and albuminuria despite maximum tolerated renin-angiotensin system inhibitor therapy.
Structural factors like cost and insurance coverage also play a role. Like other newly approved therapies, finerenone may face coverage restrictions or require prior authorization, which can delay initiation. The requirement for regular blood potassium monitoring – while entirely manageable – adds a layer of clinical administration that some practitioners find easier to avoid. Concerns about hyperkalemia and the need for ongoing laboratory monitoring have reduced enthusiasm among some clinicians, even when risks are well-characterized.
The trend is shifting. Prescription volumes continued to rise steadily through 2023 and 2024, with an additional increase following the presentation of the FINEARTS-HF trial in late 2024, which demonstrated cardiovascular benefits in heart failure patients. The FIND-CKD data presented in June 2026 – covering a non-diabetic population with limited existing options – is expected to accelerate that trajectory further, especially if Bayer’s FDA submission for the expanded indication is accepted. Targeted efforts to address specialty-specific barriers, through education, updated guidelines, and coordinated care models, may be necessary to fully realize the benefits of finerenone in appropriate patient populations.
What This Means for You
If you or someone you care for has been diagnosed with CKD – whether caused by diabetes or by another condition like hypertension or glomerulonephritis – finerenone is now a serious conversation to have with your nephrologist or primary care physician. The FIND-CKD data make clear that the kidney drug treatment benefits extend well beyond finerenone’s original FDA-approved indication. Bayer has confirmed it intends to file for an expanded approval to cover non-diabetic CKD. In the meantime, ask specifically whether you meet the criteria for the current approved use, and whether your potassium levels and kidney function are compatible with a trial of the drug.
If you already have type 2 diabetes and CKD, and you’re not currently on finerenone, ask your doctor why not. The evidence base for using it alongside an ACE inhibitor or ARB is well-established – an 18% reduction in kidney outcomes and a 14% reduction in cardiovascular outcomes from the FIDELIO-DKD trial are not numbers to dismiss. The monitoring requirements are real but straightforward: a baseline potassium test, a follow-up four weeks after starting, and routine checks thereafter. That’s a manageable trade-off for a drug that may substantially slow the loss of kidney function over years. And for the millions living with non-diabetic CKD who have spent years being told there’s nothing targeted to offer them, the FIND-CKD results mean that answer may finally be changing.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
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