NEW DELHI: A major international study has found that the drug finerenone can significantly slow the progression of chronic kidney disease (CKD) in patients who do not have diabetes, offering a promising new treatment option for a large group of patients who have long faced limited therapeutic choices.
The findings, published in the prestigious New England Journal of Medicine, are particularly relevant for countries such as India, where chronic kidney disease is emerging as a major public health challenge. Experts say the results could help delay kidney failure, reduce cardiovascular complications and improve quality of life for millions of patients.
Chronic kidney disease is often described as a “silent disease” because symptoms frequently appear only after substantial damage has already occurred. In India, the burden of CKD has been rising steadily due to increasing rates of hypertension, obesity, cardiovascular disease and ageing. While diabetes remains a leading cause of kidney failure, a significant proportion of Indian patients develop kidney disease from non-diabetic causes, including high blood pressure, glomerular diseases, infections and genetic conditions.
The international FIND-CKD trial, led by clinical pharmacologist Hiddo Lambers Heerspink of the University Medical Center Groningen in the Netherlands, followed 1,584 adults with chronic kidney disease over an average period of more than three years. All participants had impaired kidney function and elevated levels of protein in their urine, a key indicator of ongoing kidney damage and a strong predictor of disease progression.
Participants were randomly assigned to receive either finerenone or a placebo in addition to standard treatment with medicines such as ACE inhibitors or angiotensin receptor blockers, which are routinely prescribed to protect kidney function.
The results showed that patients receiving finerenone experienced a significantly slower decline in kidney function compared with those receiving standard treatment alone.
Kidney function was assessed using estimated glomerular filtration rate (eGFR), a widely used measure that indicates how effectively the kidneys filter waste products from the blood. A falling eGFR signals worsening kidney health and increases the likelihood of requiring dialysis or transplantation in the future.
Researchers found that the rate of decline in eGFR was meaningfully lower among patients taking finerenone, suggesting that the drug can help preserve kidney function for a longer period.
“The slowing of kidney function decline is not only statistically significant but also clinically important,” the investigators noted, highlighting the potential long-term benefits for patients.
Beyond protecting the kidneys, the drug was also associated with a lower risk of serious complications. The study found that finerenone reduced the likelihood of major kidney-related events, hospitalisation for heart failure and cardiovascular death.
Overall, 13.9% of patients receiving finerenone experienced such complications compared with 16.9% in the placebo group, translating into an approximately 23% reduction in risk.
This finding is particularly important because cardiovascular disease remains the leading cause of death among people with chronic kidney disease. Patients with impaired kidney function are known to face substantially higher risks of heart attacks, strokes and heart failure.
Another encouraging result was the marked reduction in protein leakage in the urine. Proteinuria, or excess protein in urine, is one of the earliest warning signs of kidney damage and is closely linked to future kidney failure.
After six months of treatment, patients receiving finerenone recorded an average reduction of more than 41% in urinary protein levels, compared with about 9% among those receiving placebo. More than half of the patients treated with finerenone achieved at least a 30% reduction in proteinuria, a change that nephrologists consider an important marker of improved kidney prognosis.
The study is noteworthy because earlier large trials involving finerenone primarily focused on patients with type 2 diabetes. The new findings demonstrate that the benefits extend to people without diabetes as well.
According to the researchers, this expands the potential role of the drug considerably. More than half of all chronic kidney disease patients globally do not have diabetes, yet treatment options for this population remain limited.
Worldwide, chronic kidney disease affects an estimated 800 million adults. In India, experts estimate that tens of millions may be living with some degree of kidney impairment, many without a formal diagnosis.
Nephrologists say the findings could help address an important gap in treatment. Current therapies mainly focus on controlling blood pressure and managing underlying causes of kidney damage. While these measures slow progression, many patients continue to experience declining kidney function over time.
The study also reported a favourable safety profile, with finerenone generally well tolerated among participants.
For India, where access to dialysis and kidney transplantation remains limited and expensive for many families, interventions that can delay disease progression are especially valuable. Dialysis not only places a substantial financial burden on households but also significantly affects quality of life.
Public health experts believe that greater awareness, early detection through routine screening of blood pressure and kidney function, and wider availability of effective therapies could help reduce the growing burden of kidney disease in the country.
The findings of the FIND-CKD study provide fresh hope that chronic kidney disease, particularly among non-diabetic patients, can be managed more effectively. As evidence continues to emerge, finerenone may become an important addition to the treatment arsenal, helping physicians preserve kidney function, prevent cardiovascular complications and delay the need for life-sustaining therapies such as dialysis and transplantation.
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