Most people with kidney disease don't have diabetes and have few effective options.
For the roughly 850 million people living with chronic kidney disease — most of them without diabetes and most of them without meaningful treatment options — a convergence of clinical evidence offers something rare: a reason for cautious hope. Three simultaneous trials, published across medicine's most prestigious journals in June 2026, found that finerenone meaningfully slows kidney decline and reduces cardiovascular death across a far broader population than the drug was originally designed to serve. The findings arrive against a backdrop of projected crisis, with kidney disease on course to become the fifth leading cause of premature death by 2040, and they raise a question that is as much ethical as medical: when a treatment demonstrably works, who bears responsibility for making it available?
- A drug approved only for diabetic kidney disease has now shown it can protect kidneys and hearts in patients who don't have diabetes — a population of hundreds of millions with almost no equivalent options.
- Three landmark trials published simultaneously in The Lancet, NEJM, and JAMA represent an unusually coordinated signal from the scientific community that something consequential has shifted.
- The numbers are striking: a 23–26% reduction in kidney failure risk, a 20% drop in cardiovascular death, and a 42% reduction in a key marker of kidney damage — benefits that held regardless of disease type or severity.
- The main safety concern, elevated blood potassium, was manageable and rarely led to patients stopping treatment, clearing one of the more significant hurdles to broader use.
- The real tension now is regulatory and systemic — whether authorities will expand finerenone's approval and whether health systems will actually deliver it to the non-diabetic patients the evidence says it can help.
Three major clinical trials have arrived at the same conclusion at the same moment: finerenone, a drug developed for kidney disease in diabetic patients, appears to protect kidneys and hearts across a much wider population than previously known. The findings were presented at the European Renal Association Congress in Glasgow in June 2026 and published simultaneously in The Lancet, The New England Journal of Medicine, and JAMA — a rare coordinated release that signals the weight researchers placed on the results.
The FIND-CKD trial, enrolling 1,584 non-diabetic patients across 24 countries, found that finerenone reduced the combined risk of kidney failure, worsening disease, heart failure, or cardiovascular death by 23 percent compared to standard care alone. A parallel analysis focused on patients with glomerular diseases — immune-related kidney conditions with historically few treatment options — found a 26 percent reduction in kidney failure or progression, and a 42 percent drop in albuminuria, a key marker of kidney damage, after just one year.
When all three studies were pooled — drawing on data from 14,574 participants with both diabetic and non-diabetic kidney disease — the results held firm. Finerenone reduced kidney failure risk by 24 percent, cut hospitalization for heart failure or cardiovascular death by 20 percent, and lowered all-cause mortality by 12 percent. These benefits were consistent regardless of diabetes status, disease type, or degree of kidney function lost.
The stakes behind these numbers are enormous. Chronic kidney disease affects around one in ten people globally — approximately 850 million individuals — and the majority do not have diabetes. For decades, non-diabetic patients have had little beyond blood pressure management and lifestyle changes. The disease is already a leading cause of death worldwide, and it is projected to become the fifth leading cause of premature death by 2040. Finerenone was generally well tolerated; elevated potassium was the primary side effect, but it rarely led to patients discontinuing treatment.
The central question now is whether regulators will extend finerenone's approval to non-diabetic kidney disease, and whether health systems will follow. The evidence exists. Whether it translates into access for the millions who need it remains an open — and urgent — question.
Three major clinical trials have converged on an unexpected finding: a kidney drug originally developed for diabetics may offer protection to millions of people with chronic kidney disease who have had almost nowhere else to turn. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, slowed the decline of kidney function, reduced the risk of kidney failure, and lowered cardiovascular death rates across patient populations far broader than anyone anticipated when the drug was first approved.
The evidence arrived all at once. In June 2026, researchers presented their findings at the European Renal Association Congress in Glasgow and published results simultaneously in three of medicine's most prestigious journals—The Lancet, The New England Journal of Medicine, and JAMA. This kind of coordinated publication across all three outlets is rare enough in clinical research to signal something significant has happened. The work was led by teams at The George Institute for Global Health and UNSW Sydney, with Professor Hiddo Heerspink and Professor Vlado Perkovic overseeing the largest trial.
The FIND-CKD trial enrolled 1,584 people with non-diabetic chronic kidney disease across 24 countries. Those who took finerenone alongside their standard treatment saw their kidney function decline more slowly than those on standard care alone. The drug reduced the combined risk of kidney failure, worsening kidney disease, heart failure, or cardiovascular death by 23 percent. A second analysis, led by Associate Professor Brendon Neuen, focused specifically on patients with glomerular diseases—conditions involving immune-related damage to the kidney's filtering units, conditions for which treatment options have been scarce. Among these patients, finerenone lowered the risk of kidney failure or disease progression by 26 percent and reduced albuminuria, a marker of protein in the urine and a sign of kidney damage, by 42 percent after a year.
When researchers pooled data from all three studies, combining results from 14,574 participants with both diabetic and non-diabetic kidney disease, the picture became even clearer. Finerenone reduced the risk of kidney failure or disease progression by 24 percent. It lowered the risk of hospitalization for heart failure or cardiovascular death by 20 percent. It reduced the risk of death from any cause by 12 percent. These benefits held steady regardless of whether patients had diabetes, what type of kidney disease they had, or how much kidney function they had lost.
The scale of the potential impact is staggering. Chronic kidney disease affects roughly one in ten people worldwide—about 850 million individuals. Most of them do not have diabetes. For decades, these patients have had few effective options beyond managing blood pressure and slowing progression through diet and lifestyle. The disease is already a major cause of illness and death globally, and projections suggest it will become the fifth leading cause of premature death by 2040. As kidney disease advances, the risks of hospitalization, cardiovascular complications, and death rise sharply, making early and effective treatment increasingly urgent.
Finerenone was generally well tolerated across all three studies. The main side effect was elevated blood potassium levels, which occurred more frequently in patients taking the drug than in those on placebo. However, treatment discontinuation and hospitalizations related to high potassium were uncommon. Neuen, speaking from his position as lead global clinical trialist at The George Institute, framed the findings as addressing a critical gap in medicine. "Although diabetes is the single most common cause of chronic kidney disease worldwide, most people living with CKD do not have diabetes and currently have few effective treatment options," he said. "Addressing this unmet need is critical, as improving outcomes in non-diabetic CKD has the potential to substantially reduce the global burden of kidney disease."
The question now is whether regulators will expand finerenone's approval beyond its current use in diabetic kidney disease, and whether health systems worldwide will make the drug available to the millions of non-diabetic patients who could benefit. If they do, the cumulative effect on global kidney disease burden could be substantial. If they don't, the findings will stand as evidence of a treatment that works—but remains out of reach for most of the people who need it.
Notable Quotes
Although diabetes is the single most common cause of chronic kidney disease worldwide, most people living with CKD do not have diabetes and currently have few effective treatment options.— Associate Professor Brendon Neuen, The George Institute
Expanding the use of finerenone in patients with CKD has the potential to meaningfully reduce kidney failure and cardiovascular complications for millions of people worldwide.— Associate Professor Brendon Neuen, The George Institute
The Hearth Conversation Another angle on the story
Why does it matter that finerenone works in non-diabetic kidney disease? Wasn't the drug already approved and in use?
It was approved, but only for diabetics with kidney disease. That's a much smaller population. The real story is that 850 million people have chronic kidney disease, and most of them don't have diabetes. They've had almost no good treatment options. This opens a door for them.
What does the drug actually do inside the kidney?
It blocks something called the mineralocorticoid receptor. When that receptor gets overactive, it triggers inflammation and scarring in kidney tissue. By blocking it, finerenone seems to slow that damage down across many different types of kidney disease, not just the diabetic kind.
The side effect you mentioned—high potassium—that sounds serious.
It can be, which is why it matters that the trials found it was uncommon enough that people rarely had to stop taking the drug because of it. It's manageable with monitoring. But it's the kind of thing that will need careful attention if the drug gets prescribed more widely.
If this works, why isn't it already being given to everyone with kidney disease?
Because it wasn't approved for that use yet. Regulatory approval is narrow and specific. The drug was tested and approved only for diabetics. These new trials are the evidence regulators need to consider expanding that approval. That process takes time.
What happens if regulators don't expand approval?
Then you have a situation where a drug that demonstrably helps millions of people remains unavailable to most of them. It's a gap between what the science shows works and what patients can actually access. That's the real tension here.