Finerenone in Glomerular Disease-Associated CKD

Key Takeaways

• Participants with investigator-reported glomerular disease within a larger nondiabetic CKD trial received finerenone 10 mg or 20 mg once daily or matching placebo.
• Finerenone was associated with slower eGFR decline, 42% lower albuminuria at 12 months, and lower kidney outcome risk.
• Detailed safety information was limited in the abstract.

In a prespecified exploratory subgroup analysis of finerenone in glomerular disease-associated CKD, finerenone was linked to a 42% reduction in albuminuria at 12 months versus matching placebo. The analysis included adults with chronic kidney disease attributed to investigator-reported glomerular diseases within a larger phase 3 randomized trial, comparing finerenone with matching placebo in this subgroup. As a prespecified exploratory subgroup analysis rather than a separate disease-specific trial, the findings reflect results within the broader study population. Across reported kidney measures, finerenone was associated with more favorable results than placebo.

The parent study was a phase 3 randomized, double-blind, placebo-controlled trial conducted across 24 countries and regions in adults with nondiabetic CKD. Eligibility required an eGFR of at least 25 to less than 60 with urinary albumin-creatinine ratio of at least 200 to less than 500 mg/g, or an eGFR of at least 25 to less than 90 with urinary albumin-creatinine ratio of at least 500 to less than 3500 mg/g. Within this subgroup, 446 participants received finerenone 10 mg or 20 mg once daily and 457 received matching placebo. Of 1584 participants, 903, or 57.0%, had investigator-reported glomerular disease, including 416 with immunoglobulin A nephropathy, 215 with focal segmental glomerulosclerosis, and 90 with membranous nephropathy.

From baseline to month 32, the total eGFR slope was -3.50 mL/min/1.73 m2 per year with finerenone and -4.23 with placebo, for a between-group difference of 0.73 mL/min/1.73 m2 per year, with a 95% CI of 0.22 to 1.24. At 12 months, albuminuria was 42% lower with finerenone than with placebo, with a 95% CI of 35% to 48%. Albuminuria was a prespecified exploratory outcome in the subgroup analysis, whereas total eGFR slope was the primary outcome of the main trial rather than a disease-specific primary end point. Both findings favored finerenone, with a less steep decline in kidney function alongside lower albuminuria.

A prespecified exploratory composite outcome was defined as kidney failure or a sustained decline in eGFR of 40% or more. Kidney failure or sustained 40% or more eGFR decline occurred at rates of 7.42 versus 9.60 events per 100 patient-years, favoring finerenone. The corresponding hazard ratio was 0.74, with a 95% CI of 0.57 to 0.97. In this subgroup, finerenone was associated with slower kidney function loss, lower albuminuria, and fewer kidney outcome events.