- Question
- Does finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improve cardiovascular outcomes in patients with type 2 diabetes across a wide range of chronic kidney disease (CKD)?
- Design
- Double-blind, randomized, placebo-controlled trial with 7437 patients randomized and a median follow-up of 3.4 years.
- Population
- Patients with type 2 diabetes and CKD: urinary albumin-to-creatinine ratio of 30 to less than 300 with an eGFR of 25 to 90 ml/min/1.73 m2 (stage 2 to 4 CKD), or a ratio of 300 to 5000 with an eGFR of at least 60 ml/min/1.73 m2 (stage 1 or 2 CKD). They were receiving renin-angiotensin system blockade adjusted to the maximum tolerated dose.
- Intervention
- Oral finerenone on top of standard renin-angiotensin system blockade.
- Control
- Placebo on top of the same background therapy.
- Primary outcome
- Composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure, analyzed as time to first event.
- Results
- The primary outcome occurred in 458 of 3686 patients (12.4%) with finerenone and 519 of 3666 (14.2%) with placebo (HR 0.87; 95% CI 0.76 to 0.98; P = 0.03), with the benefit driven mainly by fewer heart failure hospitalizations (HR 0.71; 95% CI 0.56 to 0.90). The secondary kidney composite outcome occurred in 350 patients (9.5%) with finerenone and 395 (10.8%) with placebo (HR 0.87; 95% CI 0.76 to 1.01).
- Safety
- The overall frequency of adverse events did not differ substantially between groups. Discontinuation of the trial regimen because of hyperkalemia was higher with finerenone (1.2%) than with placebo (0.4%).
- Conclusion
- In patients with type 2 diabetes and stage 2 to 4 CKD with moderately elevated albuminuria, or stage 1 or 2 CKD with severely elevated albuminuria, finerenone improved cardiovascular outcomes compared with placebo.
- Why it matters
- It extended the evidence for finerenone to patients with type 2 diabetes and a broader range of CKD, including earlier stages, and strengthened its role in cardiorenal protection, particularly for reducing heart failure hospitalizations.
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