Prespecified exploratory subgroup analysis of the FIND-CKD phase 3 RCT evaluating finerenone (10–20 mg/day orally) vs placebo in 903 adults with nondiabetic CKD due to glomerular diseases (46% IgA nephropathy, 24% FSGS, 10% membranous nephropathy), all on maximum-tolerated RAS inhibitor, followed up to 32 months across 24 countries.
Finerenone slowed eGFR decline by 0.73 mL/min/1.73 m² per year vs placebo (−3.50 vs −4.23; 95% CI 0.22–1.24), reduced albuminuria by 42% at 12 months (95% CI 35%–48%), and cut the risk of kidney failure or ≥40% eGFR decline by 26% (HR 0.74; 95% CI 0.57–0.97; 7.42 vs 9.60 events/100 patient-years). Effects were consistent across all glomerular disease subtypes and regardless of baseline SGLT2 inhibitor use.
- Exploratory subgroup analysis; trial not powered for clinical outcomes in the glomerular disease subgroup or by subtype. - ~20% of glomerular disease cases lacked kidney biopsy confirmation (though results held in biopsy-confirmed analyses). - Patients on immunosuppression and those with lupus nephritis or ANCA vasculitis were excluded, limiting generalizability to these groups.
Consider adding finerenone to RAS inhibitor therapy for patients with CKD due to glomerular diseases (IgA nephropathy, FSGS, membranous nephropathy) to slow kidney function loss and reduce albuminuria, even in those already on SGLT2 inhibitors. Monitor potassium; serious hyperkalemia rates were low and similar between arms (0.9% each).
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