- Question
- In patients with chronic kidney disease and type 2 diabetes, can finerenone, a nonsteroidal selective mineralocorticoid receptor antagonist, slow kidney disease progression and reduce cardiovascular events over the long term?
- Design
- Phase 3, randomized 1:1, double-blind, placebo-controlled, multicenter, event-driven trial including 5734 patients. Median follow-up was 2.6 years.
- Population
- Patients with chronic kidney disease and type 2 diabetes, with a urinary albumin-to-creatinine ratio of 30 to less than 300 and an eGFR of 25 to less than 60 ml/min/1.73 m² plus diabetic retinopathy, or a ratio of 300 to 5000 and an eGFR of 25 to less than 75 ml/min/1.73 m². All were on renin-angiotensin system blockade at the maximum tolerated dose.
- Intervention
- Finerenone once daily (10 mg or 20 mg per the registry) added to standard of care.
- Control
- Matching placebo once daily added to standard of care.
- Primary outcome
- Time-to-event composite of kidney failure, a sustained decrease of at least 40% in eGFR from baseline, or death from renal causes.
- Results
- The primary outcome occurred in 504 of 2833 patients (17.8%) on finerenone and 600 of 2841 (21.1%) on placebo (HR 0.82; 95% CI 0.73 to 0.93; P = 0.001). The key secondary cardiovascular composite (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke or hospitalization for heart failure) occurred in 13.0% vs 14.8% (HR 0.86; 95% CI 0.75 to 0.99; P = 0.03).
- Safety
- Overall adverse event frequency was similar between groups. Discontinuation due to hyperkalemia was more frequent with finerenone than placebo (2.3% vs 0.9%).
- Conclusion
- In patients with chronic kidney disease and type 2 diabetes, finerenone lowered the risk of kidney disease progression and cardiovascular events compared with placebo.
- Why it matters
- It provided evidence that a nonsteroidal mineralocorticoid receptor antagonist offers added kidney and cardiovascular protection on top of renin-angiotensin system blockade in diabetic kidney disease, with hyperkalemia as the main issue to monitor.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026