Finerenone in Persons with Chronic Kidney Disease without Diabetes.
In adults with non-diabetic CKD and albuminuria already on a RAS inhibitor, finerenone slowed eGFR decline versus placebo over 32 months (difference 0.7 ml/min/1.73 m2 per year) and modestly lowered a composite kidney or cardiovascular outcome, with more hyperkalemia.
Background
Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improved kidney and cardiovascular outcomes in type 2 diabetes with CKD. Its effect in CKD without diabetes was unknown. FIND-CKD (NCT05047263) tested this question.
Study design
Randomised placebo-controlled trial of adults without diabetes with CKD (eGFR 25 to <90 ml/min/1.73 m2) and albuminuria (UACR 200 to ≤3500 mg/g) on a renin-angiotensin system inhibitor. 1584 participants were assigned to finerenone 10 or 20 mg daily (n=793) or placebo (n=791). Mean baseline eGFR was about 47 ml/min/1.73 m2. The primary outcome was total eGFR slope from baseline to month 32. Secondary outcomes included a composite of ≥57% eGFR decline, kidney failure, heart failure hospitalisation or cardiovascular death.
Key findings
Mean annual eGFR change was -3.3 ml/min/1.73 m2 with finerenone versus -4.0 with placebo (difference 0.7; 95% CI 0.3 to 1.1; P<0.001). The composite kidney or cardiovascular outcome was lower with finerenone (HR 0.77; 95% CI 0.60 to 0.99; P=0.04). The kidney composite (HR 0.78; 95% CI 0.60 to 1.01) and cardiovascular composite (HR 0.60; 95% CI 0.27 to 1.33) did not individually reach significance.
Safety
Hyperkalemia was the most common adverse event: 17.0% with finerenone versus 13.3% with placebo. It led to discontinuation in 1.5% versus 0.1% and to hospitalisation in 0.9% versus 0.6%. The trial was funded by Bayer.
Category
Regulatory
Source
N Engl J Med
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.