2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/2iy5wruuedsh6.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/00yc7rcvua6a7.js","/_next/static/immutable/chunks/37ktb71aq3480.js","/_next/static/immutable/chunks/2d50b-7eu4558.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/2d6noqpp6ehas.js","/_next/static/immutable/chunks/1sx186c93bpzg.js","/_next/static/immutable/chunks/3dc-1n866s65i.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2w1bvggzb0ga8.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6e8,The renin-angiotensin-aldosterone system (RAAS) plays a central role in regulating renal hemodynamics, sodium and water balance, and cardiovascular homeostasis. Chronic RAAS activation contributes to hypertension, proteinuria, inflammation, fluid overload, and fibrosis, making RAAS blockade (RAASb) a cornerstone therapy across the kidney life cycle. Over the past decades, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists have demonstrated substantial benefits in slowing chronic kidney disease (CKD) progression, reducing proteinuria, and lowering cardiovascular risk. However, the efficacy and safety of RAASb vary according to the kidney life cycle. Evidence supports its use in proteinuric CKD and even in advanced stages, whereas the benefit in non-proteinuric disease remains limited. Novel non-steroidal mineralocorticoid receptor antagonists such as finerenone further enhance renal and cardiovascular protection, particularly in persons with diabetes and CKD. In dialysis populations, RAASb may preserve residual kidney function improve cardiac structure/function, although the benefit of steroidal MRAs remains uncertain. In kidney transplantation, RAASb appears safe and may improve long-term graft and patient survival, particularly when initiated early. The emergence of SGLT2 inhibitors and GLP-1 receptor agonists has reshaped therapeutic strategies, with accumulating evidence supporting complementary rather than competing roles with RAASb. This review synthesizes current evidence on RAAS modulation across the kidney life cycle from primary prevention to advanced CKD, dialysis, and transplantation, highlighting both established benefits and areas of current clinical uncertainty.31:T72c,ABSTRACT The renin–angiotensin–aldosterone system (RAAS) plays a central role in regulating renal hemodynamics, sodium and water balance, and cardiovascular homeostasis. Chronic RAAS activation contributes to hypertension, proteinuria, inflammation, fluid overload, and fibrosis, making RAAS blockade (RAASb) a cornerstone therapy across the kidney life cycle. Over the past decades, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists (MRAs) have demonstrated substantial benefits in slowing chronic kidney disease (CKD) progression, reducing proteinuria, and lowering cardiovascular risk. However, the efficacy and safety of RAASb vary according to the kidney life cycle. Evidence supports its use in proteinuric CKD and even in advanced stages, whereas the benefit in non-proteinuric disease remains limited. Novel non-steroidal MRAs such as finerenone further enhance renal and cardiovascular protection, particularly in persons with diabetes and CKD. In dialysis populations, RAASb may preserve residual kidney function and improve cardiac structure/function, although the benefit of steroidal MRAs remains uncertain. In kidney transplantation, RAASb appears safe and may improve long-term graft and patient survival, particularly when initiated early. The emergence of SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists has reshaped therapeutic strategies, with accumulating evidence supporting complementary rather than competing roles with RAASb. This review synthesizes current evidence on RAAS modulation across the kidney life cycle from primary prevention to advanced CKD, dialysis, and transplantation, highlighting both established benefits and areas of current clinical uncertainty.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"finerenone: generic Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on finerenone (generic). Clinician-written summaries and actionable practice insights. 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semaglutide carries multiple brand names (Wegovy, Rybelsus) across indications — clinicians should verify the specific formulation and dose per indication.","value_numeric":null},{"paper_doi":"10.1097/mnh.0000000000001225","tag_type":"warning","value":"Resmetirom's UK approval was listed as pending at time of publication (September 2026); regulatory status should be verified locally before prescribing.","value_numeric":null},{"paper_doi":"10.1097/mnh.0000000000001225","tag_type":"warning","value":"Semaglutide's UK approval for MASH was also listed as pending at publication; verify current local authorization before clinical use.","value_numeric":null},{"paper_doi":"10.1097/mnh.0000000000001225","tag_type":"warning","value":"The CRHM nomenclature used throughout is not yet consensus-endorsed by any major society; clinicians should note this framework is proposed, not official.","value_numeric":null},{"paper_doi":"10.1097/mnh.0000000000001225","tag_type":"warning","value":"This is a narrative review; evidence levels cited for individual recommendations reflect the underlying trials, which are largely single-domain RCTs not designed for CRHM multimorbidity populations. No sample size applies to the review itself.","value_numeric":null}],"summaries":{"what_studied":"This review examines the mechanistic, epidemiological, and therapeutic evidence for integrating the liver into the cardiovascular-kidney-metabolic (CKM) framework, proposing the term cardiovascular-renal-hepatic-metabolic (CRHM) syndrome. It covers pathophysiology (lipotoxicity, ectopic fat, gut-liver axis, neurohormonal activation) and recent trial data (2024–2025) across GLP-1 receptor agonists, SGLT2 inhibitors, nonsteroidal MRAs, and resmetirom.","key_result":"Coexistent MASLD and CKD confer additive, stage-dependent mortality risk exceeding either condition alone; hepatic fibrosis severity — not steatosis — is the dominant prognostic driver. Semaglutide achieved steatohepatitis resolution in 62.9% vs. 34.3% (placebo) in ESSENCE, and is now the first agent with regulatory approval across all four CRHM domains. Resmetirom became the first licensed MASH-specific therapy (FDA approval March 2024; EC authorization August 2025). Tirzepatide reduced composite CV death/worsening HF by 38% vs. placebo in HFpEF (SUMMIT).","limitations":"- All current major cardiorenal and MASH outcome trials systematically exclude the overlapping CRHM phenotype, limiting generalizability to real-world multimorbid patients.\n- No head-to-head combination therapy trial exists; the proposed multi-drug CRHM regimen is extrapolated from single-disease trials.\n- Liver-related death is a competing risk that can bias conventional time-to-event analyses in CKD/MASLD cohorts but is rarely accounted for.","practice_takeaway":"Calculate FIB-4 in any CKD patient with at least one cardiometabolic risk factor; values above 1.3 should prompt elastography-based fibrosis staging to guide both risk stratification and drug selection. For confirmed MASLD with significant fibrosis, build a regimen around ACEi/ARB + SGLT2i + GLP-1RA, adding finerenone (if T2DM, UACR >30 mg/g, eGFR ≥25) and resmetirom (if noncirrhotic F2–F3, eGFR ≥45) where criteria are met."}},{"doi":"10.1093/ckj/sfag280","pmid":null,"title":"PRO/CON debate: non-steroidal versus steroidal mineralocorticoid receptor antagonists in chronic kidney disease: progress, pragmatism, and remaining uncertainties","journal_title":"Clinical Kidney Journal","journal_issn":"2048-8505","published_at":"2026-08-17T00:00:00.000Z","url":"https://doi.org/10.1093/ckj/sfag280","source_score":18,"is_retracted":false,"is_open_access":null,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":false},"created_at":"2026-08-21T06:28:16.833Z","updated_at":"2026-08-21T06:28:16.833Z","tags":[{"paper_doi":"10.1093/ckj/sfag280","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"condition","value":"Albuminuria","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"condition","value":"Resistant Hypertension","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"condition","value":"Type 2 Diabetes","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"generic","value":"eplerenone","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"generic","value":"spironolactone","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"modality","value":"Non-Steroidal Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"modality","value":"Renin-Angiotensin System Blocker","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"modality","value":"Steroidal Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"study_design","value":"Pro/Con Debate (Narrative Review)","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"warning","value":"No sample size is applicable as this is an opinion/review format.","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"warning","value":"Study design label 'Pro/Con Debate' is non-standard; classified broadly as Narrative Review for evidence hierarchy purposes.","value_numeric":null},{"paper_doi":"10.1093/ckj/sfag280","tag_type":"warning","value":"This is a pro/con debate article, not a primary research study — no new trial data are reported; conclusions are based on synthesis of existing evidence.","value_numeric":null}],"summaries":{"what_studied":"This pro/con debate evaluates non-steroidal MRAs (primarily finerenone) versus steroidal MRAs (spironolactone, eplerenone) for cardiorenal protection in CKD, comparing efficacy, tolerability, pharmacokinetics, and real-world applicability across heterogeneous CKD populations.","key_result":"Finerenone reduces risk of kidney failure and major cardiovascular events when added to RAS blockade in type 2 diabetes with albuminuric CKD, including in combination with SGLT2 inhibitors; steroidal MRAs retain advantages in blood pressure lowering, cost, and access.","limitations":"This is a debate/opinion article, not a primary trial; direct head-to-head RCT data between nsMRAs and steroidal MRAs are not presented. Conclusions on steroidal MRAs rely on older or indirect evidence rather than large dedicated CKD outcome trials.","practice_takeaway":"For patients with type 2 diabetes and albuminuric CKD on RAS blockade, finerenone offers proven cardiorenal outcome benefits with better tolerability. In resistant hypertension or resource-limited settings, steroidal MRAs remain a practical and cost-effective option."}},{"doi":"10.1001/jamacardio.2026.2104","pmid":"42418169","title":"Finerenone and Blood Pressure in Heart Failure With Mildly Reduced or Preserved Ejection Fraction","journal_title":"JAMA Cardiology","journal_issn":"2380-6583","published_at":"2026-07-08T00:00:00.000Z","url":"https://eprints.gla.ac.uk/view/journal_volume/JAMA_Cardiology.html>,","source_score":50,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-17T13:33:01.465Z","updated_at":"2026-08-17T13:33:01.465Z","tags":[{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"brand","value":"Kerendia","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"condition","value":"Heart Failure With Mildly Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"condition","value":"Heart Failure With Preserved Ejection Fraction","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"condition","value":"Hypertension","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"sample_size","value":"n=5999","value_numeric":5999},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"warning","value":"Multiple authors have financial relationships with Bayer AG, the trial sponsor, which funded the study and was involved in study supervision and data collection.","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"warning","value":"The brand name 'Kerendia' is assigned based on known finerenone branding; the paper itself does not mention a brand name.","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.2104","tag_type":"warning","value":"This is a prespecified secondary/subgroup analysis of the FINEARTS-HF trial, not the primary trial report — causal mediation estimates should be interpreted cautiously given wide confidence intervals crossing zero.","value_numeric":null}],"summaries":{"what_studied":"This prespecified secondary analysis of the FINEARTS-HF RCT examined the blood pressure (BP) effects of finerenone vs placebo in 5,999 adults with HFmrEF/HFpEF (mean age 72 years, 45% female, mean baseline SBP 129 mmHg), and whether baseline BP or BP reduction mediated finerenone's cardiovascular benefits over up to 36 months.","key_result":"Finerenone produced an early, sustained SBP reduction (overall placebo-adjusted mean: −3.1 mmHg; 95% CI, −3.6 to −2.6; P<.001), consistent across all baseline SBP categories. Cardiovascular death and total HF events were reduced irrespective of baseline SBP or DBP (P for interaction .96 and .83, respectively), and causal mediation analysis showed only ~7.4% of finerenone's benefit was mediated by SBP change (95% CI, −0.7 to 27.0).","limitations":"- No 24-hour ambulatory BP monitoring, limiting BP characterization.\n- Exclusion of patients with symptomatic hypotension or uncontrolled SBP ≥160 mmHg (or ≥180 mmHg) may limit generalizability to extreme BP ranges.\n- Industry-sponsored trial (Bayer AG) with multiple author conflicts of interest.","practice_takeaway":"Finerenone lowers BP modestly but its cardiovascular benefit in HFmrEF/HFpEF is not driven by BP reduction — clinicians can use it across a broad baseline BP range without concern that only hypertensive patients benefit. The ~1.6–2.0× higher odds of SBP <100 mmHg events with finerenone vs placebo were consistent across BP subgroups, so monitoring for hypotension remains relevant regardless of baseline BP."}},{"doi":"10.1093/ndt/gfag150","pmid":"42360710","title":"Systolic blood pressure and albuminuria reduction mediate cardiovascular benefits of finerenone in T2 diabetes and CKD","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-06-26T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag150","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-01T13:27:18.784Z","updated_at":"2026-07-01T13:27:18.784Z","tags":[{"paper_doi":"10.1093/ndt/gfag150","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"brand","value":"Kerendia","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"condition","value":"Type 2 Diabetes","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"sample_size","value":"n=12143","value_numeric":12143},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"study_design","value":"Causal Mediation Analysis","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"warning","value":"Sex breakdown of the FIDELITY pooled cohort is not specified in the abstract; 'mixed' sex tag is inferred from prior FIDELITY publications.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"warning","value":"The joint mediation CI of 21–100% is very wide; the upper bound of 100% should not be interpreted as near-certainty of complete mediation.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag150","tag_type":"warning","value":"The study design is a post-hoc causal mediation analysis of pooled RCT data (FIDELITY), not a prospectively powered mediation trial — the 'level 2' evidence rating reflects the RCT origin of the data, but mediation estimates carry additional analytical assumptions.","value_numeric":null}],"summaries":{"what_studied":"Causal mediation analysis of FIDELITY pooled data (n=12,143 adults with T2D and CKD) to quantify how much of finerenone's long-term cardiovascular benefit (CV death, nonfatal MI, nonfatal stroke, HF hospitalization) is mediated by 4-month changes in UACR, SBP, body weight, and serum potassium.","key_result":"Early reductions in UACR (−32.2%) and SBP (−3.6 mmHg) together mediated 50% (95% CI 21–100%) of finerenone's cardiovascular benefit; UACR alone mediated 39% (95% CI 7–71%) and SBP alone 21% (95% CI 3–40%). Body weight (−0.23 kg) and serum potassium (+0.19 mEq/L) changes did not mediate cardiovascular outcomes.","limitations":"- Wide confidence intervals (e.g., joint mediation 21–100%) reflect residual uncertainty about the true mediated fraction.\n- Mediation analysis assumes no unmeasured confounding of the mediator–outcome relationship, which cannot be fully guaranteed.\n- All data derive from a single pooled trial program (FIDELITY), limiting external generalizability.","practice_takeaway":"In patients with T2D and CKD on finerenone, early drops in UACR and SBP at 4 months are meaningful signals of cardiovascular efficacy — not just renal markers. Monitoring both within the first few months can help confirm the drug is working as intended."}},{"doi":"10.1038/s41581-026-01098-6","pmid":"42343109","title":"Benefits of finerenone treatment across chronic kidney disease aetiologies","journal_title":"Nature Reviews Nephrology","journal_issn":"1759-5061","published_at":"2026-06-24T00:00:00.000Z","url":"https://doi.org/10.1038/s41581-026-01098-6","source_score":8,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-29T13:22:45.392Z","updated_at":"2026-06-29T13:22:45.392Z","tags":[{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"brand","value":"Kerendia","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"condition","value":"Glomerular Disease","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"study_design","value":"Research Highlight / Clinical Trial Summary","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"warning","value":"Level of evidence is assigned based on the underlying RCT design described; the highlight itself is a secondary summary and does not constitute primary evidence.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"warning","value":"Study design tag reflects that this article summarizes two primary RCTs (FIND-CKD and a glomerular disease substudy); it is not itself an original trial report.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"warning","value":"The brand name 'Kerendia' was inferred from known finerenone branding; it is not explicitly stated in this article.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01098-6","tag_type":"warning","value":"This is a research highlight/editorial summary, not the full FIND-CKD trial report — quantitative primary endpoint results (e.g., hazard ratios, absolute risk reductions) are not available from this text alone.","value_numeric":null}],"summaries":{"what_studied":"This research highlight summarizes findings from the FIND-CKD trial (presented at the 63rd European Renal Association Congress) evaluating finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in people with CKD **without** diabetes — extending prior evidence beyond the diabetic CKD population. A second referenced study examined finerenone specifically in CKD due to glomerular diseases.","key_result":"Finerenone demonstrated kidney and cardiovascular protective benefits in people with CKD without diabetes. Hyperkalaemia occurred in 17% of treated patients vs. 13.3% on placebo, with a modest mean serum potassium increase of 0.12 mmol/L between groups; the drug was overall safe and well tolerated.","limitations":"This is a brief research highlight, not the full trial report — specific primary endpoint data, effect sizes, and sample sizes are not provided. Full details require access to the primary publications in NEJM and JAMA.","practice_takeaway":"Finerenone may benefit patients with CKD regardless of diabetes status, including those with glomerular disease. Monitor serum potassium closely — hyperkalaemia rates were higher with treatment (17% vs. 13.3%), though the absolute potassium rise was small (0.12 mmol/L)."}},{"doi":"10.1093/eurheartj/ehag426","pmid":"42284132","title":"Albuminuria and heart failure","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-06-12T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag426","source_score":26,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:08.577Z","updated_at":"2026-06-22T13:24:08.577Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"condition","value":"Albuminuria","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"condition","value":"Hypertension","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"condition","value":"Type 2 Diabetes","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"modality","value":"Renin-Angiotensin System Inhibitor","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"warning","value":"No specific patient-level sample size applies to this review article; the sample_size tag has been omitted accordingly.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag426","tag_type":"warning","value":"This is a narrative review; conclusions on UACR as a modifiable target are based on association data from clinical trials, not direct causal evidence. The impact_flag 'practice_changing' reflects the review's call for routine UACR screening not yet universally adopted in HF guidelines, which may be aspirational rather than established practice.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the role of albuminuria (measured by urinary albumin-to-creatinine ratio, UACR) as a risk marker and potentially modifiable factor in heart failure — covering its prevalence, prognostic value, measurement approaches, guideline recommendations, and the effect of HF therapies on UACR.","key_result":"Albuminuria is present in nearly half of all HF patients and is an independent risk marker for incident HF and worse outcomes in pre-existing HF. Reductions in UACR with guideline-directed therapies (RAASi, SGLT2 inhibitors, finerenone) are associated with lower cardiovascular, HF, and CKD event rates.","limitations":"This is a narrative review, so it does not provide new primary data or meta-analytic pooling. Causal directionality of UACR reduction on outcomes remains uncertain — albuminuria may be a marker rather than a proven modifiable target.","practice_takeaway":"Consider routine UACR screening in HF patients, as it identifies high-risk individuals who may benefit from targeted therapy. SGLT2 inhibitors and finerenone reduce UACR and may offer dual cardiovascular and renal protection in this population."}},{"doi":"10.1001/jama.2026.9923","pmid":"42246414","title":"Finerenone in Patients With Chronic Kidney Disease Due to Glomerular Diseases","journal_title":"JAMA","journal_issn":"0098-7484","published_at":"2026-06-05T00:00:00.000Z","url":"https://doi.org/10.1001/jama.2026.9923","source_score":202,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:23:40.857Z","updated_at":"2026-06-10T14:23:40.857Z","tags":[{"paper_doi":"10.1001/jama.2026.9923","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"brand","value":"Kerendia","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"condition","value":"Focal Segmental Glomerulosclerosis","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"condition","value":"Glomerular Disease","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"condition","value":"IgA Nephropathy","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"condition","value":"Membranous Nephropathy","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"sample_size","value":"n=903","value_numeric":903},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"warning","value":"Brand name 'Kerendia' assigned based on known finerenone branding; the paper itself does not mention a brand name.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"warning","value":"Level of evidence tagged as '2' reflects the RCT design, but the subgroup/exploratory nature slightly reduces certainty compared to a primary powered trial.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"warning","value":"The main FIND-CKD trial results (Heerspink et al., NEJM, June 5, 2026) are referenced but not fully reproduced here; findings in the broader nondiabetic CKD population may differ.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9923","tag_type":"warning","value":"This is a prespecified exploratory subgroup analysis, not the primary trial report; causal conclusions should be interpreted cautiously despite the consistency of findings.","value_numeric":null}],"summaries":{"what_studied":"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.","key_result":"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.","limitations":"- Exploratory subgroup analysis; trial not powered for clinical outcomes in the glomerular disease subgroup or by subtype.\n- ~20% of glomerular disease cases lacked kidney biopsy confirmation (though results held in biopsy-confirmed analyses).\n- Patients on immunosuppression and those with lupus nephritis or ANCA vasculitis were excluded, limiting generalizability to these groups.","practice_takeaway":"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)."}},{"doi":"10.1056/nejmoa2604625","pmid":"42246672","title":"Finerenone in Persons with Chronic Kidney Disease without Diabetes","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-06-04T00:00:00.000Z","url":"https://doi.org/10.1056/nejmoa2604625","source_score":316,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-11T13:42:56.228Z","updated_at":"2026-06-11T13:42:56.228Z","tags":[{"paper_doi":"10.1056/nejmoa2604625","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"brand","value":"Kerendia","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"sample_size","value":"n=1584","value_numeric":1584},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"warning","value":"Exact etiologies of CKD in the trial population are not described in the abstract; applicability to specific CKD subtypes (e.g., IgA nephropathy, FSGS) is uncertain.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"warning","value":"Participants were required to already be on a RAS inhibitor — results may not generalize to patients who are RAS-inhibitor naive or intolerant.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604625","tag_type":"warning","value":"The cardiovascular composite secondary outcome was not statistically significant and the confidence interval was wide; CV benefit should not be assumed in non-diabetic CKD based on this trial alone.","value_numeric":null}],"summaries":{"what_studied":"This RCT (FIND-CKD) evaluated finerenone (10 or 20 mg daily) vs. placebo in 1,584 adults with CKD (eGFR 25–<90 ml/min/1.73 m²) and albuminuria (UACR 200–3500 mg/g) who did **not** have diabetes, all on background RAS inhibitor therapy, over 32 months.","key_result":"Finerenone slowed eGFR decline vs. placebo (−3.3 vs. −4.0 ml/min/1.73 m²/year; difference +0.7, 95% CI 0.3–1.1; P<0.001) and reduced the composite kidney/CV outcome (HR 0.77, 95% CI 0.60–0.99; P=0.04). Hyperkalemia occurred in 17.0% vs. 13.3%; discontinuations due to hyperkalemia were 1.5% vs. 0.1%.","limitations":"- The cardiovascular composite alone was underpowered (HR 0.60, 95% CI 0.27–1.33), limiting CV conclusions.\n- Trial duration was 32 months; longer-term kidney protection and safety data are lacking.\n- Industry-funded (Bayer), which may introduce sponsor bias.","practice_takeaway":"Consider adding finerenone to RAS inhibitor therapy for non-diabetic CKD patients with significant albuminuria (UACR 200–3500 mg/g) to slow eGFR decline and reduce kidney/CV events. Monitor potassium closely — hyperkalemia requiring drug discontinuation was 15× more common with finerenone (1.5% vs. 0.1%)."}},{"doi":"10.1111/dom.70934","pmid":"42219273","title":"Adding Finerenone to\n SGLT2\n Inhibitors and Long‐Term Kidney Outcomes in Diabetic Kidney Disease","journal_title":"Diabetes, Obesity and Metabolism","journal_issn":"1462-8902","published_at":"2026-05-31T00:00:00.000Z","url":"https://doi.org/10.1111/dom.70934","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-07T13:26:42.698Z","updated_at":"2026-06-07T13:26:42.698Z","tags":[{"paper_doi":"10.1111/dom.70934","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"brand","value":"Kerendia","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"modality","value":"Renin-Angiotensin System Inhibitor","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"sample_size","value":"n=255","value_numeric":255},{"paper_doi":"10.1111/dom.70934","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"study_design","value":"Observational Cohort Study with Propensity Score Matching","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"Sex distribution of the study population is not explicitly reported in the abstract; 'mixed' is inferred from typical DKD trial populations.","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"The brand name 'Kerendia' is assumed for finerenone; the paper does not explicitly state the brand.","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously — this is an observational study and not an RCT; findings are hypothesis-generating and supportive, not definitive.","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"The study does not report hard clinical endpoints (e.g., ESKD, cardiovascular mortality), limiting direct clinical impact assessment.","value_numeric":null}],"summaries":{"what_studied":"In 255 patients with diabetic kidney disease (DKD) already on combined RASi + SGLT2i therapy, this study evaluated whether adding finerenone (triple combination therapy, TCT) improved proteinuria, eGFR slope, and serum potassium over 24 months compared to dual therapy (DCT) alone, using intention-to-treat analysis with propensity score matching.","key_result":"TCT reduced proteinuria by 47% at 24 months (p=0.028). The post-initial dip eGFR slope was significantly better with TCT vs. DCT: ~1.31 mL/min/1.73 m²/year less annual decline (95% CI: 0.25–2.36; p=0.015), persisting after PS matching (difference 1.45 mL/min/1.73 m²/year; 95% CI: 0.32–2.58; p=0.012). Total eGFR slope did not differ significantly. Serum potassium rose modestly early but equalized by 24 months.","limitations":"- Observational, single-arm propensity score–matched design limits causal inference and may not fully control for confounding.\n- Relatively small sample (n=255) with only 24-month follow-up; longer-term hard outcomes (ESKD, doubling of creatinine, cardiovascular events) not reported.\n- Real-world adherence and dose titration of finerenone not described, which could affect generalizability.","practice_takeaway":"For patients with DKD already on RASi + SGLT2i, adding finerenone may further slow kidney function decline and meaningfully reduce proteinuria — consider triple therapy as part of a comprehensive kidney-protective strategy. Monitor potassium closely in the early weeks after starting finerenone, though levels appear to stabilize by 24 months."}},{"doi":"10.1038/s41581-026-01078-w","pmid":"42098477","title":"Epidemiology of cardiovascular–kidney–metabolic syndrome","journal_title":"Nature Reviews Nephrology","journal_issn":"1759-5061","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1038/s41581-026-01078-w","source_score":11,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-16T13:22:29.340Z","updated_at":"2026-05-16T13:22:29.340Z","tags":[{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"condition","value":"Cardiovascular-Kidney-Metabolic Syndrome","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"condition","value":"Type 2 Diabetes","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"generic","value":"canagliflozin","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"generic","value":"dapagliflozin","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"generic","value":"empagliflozin","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"generic","value":"semaglutide","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"generic","value":"tirzepatide","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"modality","value":"Non-Steroidal Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"warning","value":"No specific sample size applies — the paper synthesizes findings from multiple epidemiological datasets across different countries and time periods.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the broad framing of CKM syndrome as a new unifying clinical construct, not a single RCT result.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01078-w","tag_type":"warning","value":"This is a narrative review, not a systematic review or meta-analysis; study selection may reflect author perspective.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examines the global epidemiology of cardiovascular–kidney–metabolic (CKM) syndrome — formally defined by the AHA in 2023 — including its staging framework (stages 0–4), prevalence, demographic disparities, risk determinants, and the real-world uptake of modern therapies (GLP-1 receptor agonists, SGLT2 inhibitors, non-steroidal MRAs).","key_result":"Most adults worldwide already meet criteria for stage ≥1 CKM syndrome; stage 2 (metabolic risk factors or CKD) is the most prevalent. 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novel non-steroidal MRAs (e.g., finerenone) add renal and cardiovascular protection in diabetic CKD; benefit in non-proteinuric disease is limited; in dialysis, RAASb may preserve residual kidney function and improve cardiac structure; in transplantation, early RAASb appears safe and may improve graft and patient survival.","limitations":"- Review article (not a meta-analysis or RCT); conclusions are synthesis-level and inherit the limitations of underlying studies.\n- Efficacy and safety data in dialysis populations and transplant recipients remain uncertain, particularly for steroidal MRAs in dialysis.\n- Evidence on optimal timing, agent selection, and combination with newer agents (SGLT2i, GLP-1 RA) across all lifecycle stages is still evolving.","practice_takeaway":"Use RAASb as first-line therapy in proteinuric CKD and consider adding finerenone in patients with diabetes and CKD for added renal and cardiovascular protection. In transplant recipients, early initiation of RAASb appears safe and may improve long-term outcomes; SGLT2 inhibitors and GLP-1 receptor agonists play a complementary — not competing — role alongside RAASb."}}],"initialOffset":11,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"generic","value":"finerenone"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Generics","href":"/hub/tag/generic"},{"name":"finerenone"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"generic","hub_tag_value":"finerenone"}}}]]

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