Every day your kidneys filter something like 180 litres of blood, sieving out waste while clinging to the things your body wants to keep. When that machinery starts to fail, it rarely does so loudly. Protein begins leaking into the urine, the filtration rate creeps downward, and the slide, once it starts, tends to keep going. For a huge slice of patients, doctors have had little to throw at that slide beyond the standard blood-pressure pills. Until now, perhaps.
A drug called finerenone, already approved for people whose kidney disease stems from type 2 diabetes, has just been shown to slow that decline in people who do not have diabetes at all. That matters more than it might sound, because more than half of the world’s chronic kidney disease has nothing to do with diabetes.
The evidence comes from FIND-CKD, the largest phase III trial yet to tackle non-diabetic kidney disease, with results published in the New England Journal of Medicine and presented at the European Renal Association congress in Glasgow this week. Researchers randomly assigned 1,584 adults, all of them already on standard renin-angiotensin system blockers, to take either finerenone or a dummy pill daily. Then they watched, for an average of just over three years, to see whose kidneys held up. Finerenone is what pharmacologists call a nonsteroidal mineralocorticoid receptor antagonist, which is a mouthful, but the gist is that it dampens a hormonal signal that drives inflammation and scarring in the kidney.
The headline number is small. It is also, the researchers reckon, genuinely meaningful.
Kidney function gets tracked through the estimated glomerular filtration rate, or eGFR, which is basically how fast the kidneys clean the blood. Over 32 months, eGFR fell by roughly 3.3 units a year in the finerenone group against about 4.0 in the placebo group. A difference of 0.7 per year. That sounds trivial, but stretched across the decades a kidney patient lives with their disease, it is the sort of gap that can push back the day someone needs dialysis or a transplant.
A Familiar Drug, an Unfamiliar Crowd
What surprised the team was less the size of the effect than the breadth of it. The trial swept in people with hypertension-related kidney damage, with glomerular diseases, with a whole grab-bag of underlying causes that had little in common except a failing organ and few good options. “Now it turns out the drug is also effective in people without diabetes, even though more than half of all CKD patients worldwide are non-diabetic,” says Hiddo Lambers Heerspink, the clinical pharmacologist at the University Medical Center Groningen who led the work. “Chronic kidney disease now affects an estimated 800 million adults worldwide.”
The benefit was not confined to filtration rate. Finerenone also cut the risk of a nastier composite outcome, things like kidney failure, hospitalisation for heart failure, or death from cardiovascular causes. “In the finerenone group, 13.9 percent experienced such a complication, compared to 16.9 percent in the placebo group,” Lambers Heerspink notes. “That amounts to a reduction in risk of approximately 23 percent.”
Then there is the protein. Albuminuria, protein spilling into the urine, is one of the earliest and most ominous tells of a kidney in trouble, and finerenone hammered it. “In the finerenone group, it decreased by an average of over 41 percent, compared to about 9 percent in the placebo group,” says Lambers Heerspink, adding that more than half of those on the drug saw their urinary protein drop by at least 30 percent, which tends to flag a better long-term outlook.
The Catch, and It Is a Real One
No drug is free. The most common side effect was hyperkalaemia, a build-up of potassium in the blood that can, at its worst, throw off the heart’s rhythm. It showed up in 17 percent of finerenone takers versus 13.3 percent on placebo. Mostly it was manageable; only a handful of people, around 1.5 percent, had to quit the drug because of it, and hospital admissions for the problem were rare in both groups. Acute kidney injury, the thing you might most fear from a kidney drug, cropped up at much the same rate either way.
It is worth a note of caution here. The trial was funded by Bayer, which makes finerenone, and the analyses were checked by independent statisticians, though the headline endpoint, that 0.7-unit slowing, is modest by any reading. Whether regulators and guideline committees decide it clears the bar for a brand-new indication is a separate question from whether the biology holds up.
Still, for a patient group that the guidelines have largely left in the cold, the calculus shifts. “Finerenone could become an important new treatment option for people with chronic kidney disease who do not have diabetes,” says Lambers Heerspink, pointing to “a broad, underserved patient population with non-diabetic CKD, for whom there are few treatment options in the guidelines.” For the better part of a billion people whose kidneys are quietly winding down, that is not nothing. The next slide, you might say, may have just got a little less steep.
Source: New England Journal of Medicine, DOI 10.1056/NEJMoa2604625
Frequently Asked Questions
Why does it matter that finerenone works in people without diabetes?
Most large trials of finerenone studied patients whose kidney disease was driven by type 2 diabetes, so that is where its use has been concentrated. But more than half of the world’s chronic kidney disease cases are not diabetes-related, and those patients have had few targeted options beyond standard blood-pressure drugs. Showing a benefit in this group opens the door to a much wider population.
How much does the drug actually slow kidney decline?
Over 32 months, kidney filtration rate fell about 0.7 units per year more slowly in the finerenone group than in the placebo group. That gap looks small in a single year, but kidney disease unfolds over decades, so a sustained slowing can meaningfully delay kidney failure. The drug also reduced a composite of serious kidney and heart outcomes by roughly 23 percent.
Is finerenone safe to take?
In the trial its safety profile matched earlier studies, with no new red flags. The main concern is hyperkalaemia, raised blood potassium, which was more common on the drug but rarely forced people to stop or land in hospital. Acute kidney injury occurred at similar rates in both groups.
Can I get finerenone for non-diabetic kidney disease now?
Not automatically. These results were published in June 2026, and the drug’s existing approvals centre on diabetic kidney disease, so regulators and guideline committees will need to weigh the evidence before any broader use becomes standard. The trial was also funded by the drug’s manufacturer, which is normal but worth knowing.
ScienceBlog.com has no paywalls, no sponsored content, and no agenda beyond getting the science right. Every story here is written to inform, not to impress an advertiser or push a point of view.
Good science journalism takes time — reading the papers, checking the claims, finding researchers who can put findings in context. We do that work because we think it matters.
If you find this site useful, consider supporting it with a donation. Even a few dollars a month helps keep the coverage independent and free for everyone.