Finerenone Evidence Broadens Across CKD Types: Hiddo Heerspink, PhD

Finerenone (Kerendia; Bayer) is showing kidney-protective signals in groups that have been left out of kidney outcomes trials or have few treatment options, including people with type 1 diabetes and focal segmental glomerulosclerosis (FSGS), said Hiddo J. Heerspink, PhD, professor of clinical trials and personalized medicine at University Medical Center Groningen in the Netherlands, in an interview with The American Journal of Managed Care^®.

Heerspink is an author on multiple finerenone abstracts presented at the American Society of Nephrology (ASN) Kidney Week 2026. One pairs the phase 3 FINE-ONE trial¹ with the FIDELITY pooled analysis.² FINE-ONE (NCT05901831) enrolled 242 adults with chronic kidney disease (CKD) and type 1 diabetes and found a 25% relative reduction in urine albumin-to-creatinine ratio vs placebo over 6 months. The FDA approved finerenone for CKD associated with type 1 diabetes³ in September. The other 2 abstracts draw on FIND-CKD,^4,5 a phase 3 trial of 1584 adults with CKD without diabetes⁶ in which finerenone slowed the annual decline in estimated glomerular filtration rate (eGFR) by 0.7 mL/min/1.73 m² compared with placebo. In a prespecified analysis in glomerular disease,⁷ IgA nephropathy accounted for 46.1% of 903 participants and FSGS for 23.8%, although the trial was not powered to assess kidney outcomes within individual subtypes.

Heerspink discussed what long-term data from a type 2 diabetes cohort could mean for people with type 1 diabetes, how finerenone performed in FSGS, where it fits in IgA nephropathy as new targeted therapies emerge, and the open questions about sequencing.

This interview was edited for clarity.

AJMC: Patients with type 1 diabetes have traditionally been left out of most kidney outcomes trials. What do the FINE-ONE and FIDELITY findings mean for these patients?

Heerspink: This is really important because, as you say, patients with type 1 diabetes and CKD are usually not included in these studies. That’s why we conducted the FINE-ONE study. But the FINE-ONE study only had 26 weeks of follow-up, so we could only assess short-term effects on albuminuria. Albuminuria is a validated surrogate end point for type 1 diabetes. But we also wanted to know whether the effect of finerenone on albuminuria could translate into long-term protection.

What we did was match the type 1 diabetes population, basically, to patients with type 2 diabetes we have followed for a long time, for about 3.5 years. By matching these patients, we created a cohort of type 1–like patients, but now with type 2 diabetes, who were treated for 3.5 years with finerenone. We saw that in that population, finerenone slowed eGFR decline and reduced the risk of kidney and cardiovascular end points, and this provides confidence that the effect of finerenone in type 1 diabetes on albuminuria truly translates into long-term kidney protection.

AJMC: Looking at the FIND-CKD analyses in FSGS and IgA nephropathy, what do they show for diseases that have few treatment options? Starting with FSGS.

Heerspink: This means a lot for patients with FSGS because there are very few effective drugs for patients with FSGS. We show now that finerenone in patients with FSGS significantly reduced the decline in eGFR to 4.7 mL/min/1.73 m² per year from 3.3 mL/min/1.73 m² per year, so a difference of 1.3 mL/min/1.73 m² per year and a 40% reduction in the risk of kidney failure or 40% eGFR decline, which is an accepted end point. Although this effect was just not statistically significant, the P value was 0.06. That shows that the effect, at least, suggests that the effect on eGFR translates into long-term kidney benefits.

They also show that finerenone in patients with FSGS is safe. There were no more adverse events or serious adverse events, and even the number of patients with hyperkalemia was similar between the placebo group and the finerenone group. So finerenone in patients with FSGS is effective and safe and thus represents the first drug for these patients to slow the decline in GFR and protect long-term [kidney function].

AJMC: In IgA nephropathy, where does finerenone sit alongside newer targeted therapies and those in development?

Heerspink: In IgA nephropathy [IgAN], we see many new therapies…that were presented at the ASN, and we know that there are complement inhibitors being developed. Finerenone is another drug. Finerenone is a general treatment for patients with IgAN, so it doesn’t directly affect the immune system. It can be added on top of the other medications for patients who, with the newer medications, do not reach the target threshold of [eGFR] decline of less than 1 mL/min per year. It’s an additive supportive medication alongside SGLT2 [sodium-glucose cotransporter 2] inhibition and RAS inhibition.

AJMC: There are finerenone, SGLT2 inhibitors, incretin therapy, and complement inhibitors, all being stacked or sequenced. How does it all play together?

Heerspink: That’s the question for the future. How should we sequence these therapies? Which therapy should we start with? Which should we add? When should we start therapies? And for which patients should we start which therapy? These are the questions for the future. We now have a menu of these drugs, and we have to find out how to best use them in clinical practice.

References

1. Campbell P. Finerenone improves UACR in T1D, CKD. AJMC. November 7, 2025. Accessed October 22, 2026. https://www.ajmc.com/view/finerenone-improves-uacr-in-t1d-ckd
2. Herspink HJL, Kwak SH, Solis-Herrera C, et al. Effects of finerenone on kidney and cardiovascular outcomes in patients with CKD and type 1 diabetes: an analysis from FINE-ONE and FIDELITY. Presented at: ASN Kidney Week; October 21-25, 2026; Denver, Colorado. Poster TH-PO1239.
3. McCormick B. FDA expands finerenone approval to CKD associated with type 1 diabetes. AJMC. September 17, 2026. Accessed October 22, 2026. https://www.ajmc.com/view/fda-expands-finerenone-approval-to-ckd-associated-with-type-1-diabetes
4. Heerspink HJL, Floege J, Smeijer JD, et al. Finerenone in patients with FSGS: a FIND-CKD analysis. Presented at: ASN Kidney Week; October 21-25, 2026; Denver, Colorado. Poster TH-PO1240.
5. Lange Neuen B, Barratt J, Floege J, et al. Finerenone in patients with IgA nephropathy: a FIND-CKD analysis. Presented at: ASN Kidney Week; October 21-25, 2026; Denver, Colorado. Poster TH-PO1253.
6. Three studies show how finerenone fares for nondiabetic CKD, across CKD etiologies. Healio. July 16, 2026. Accessed October 22, 2026. https://www.healio.com/news/nephrology/20260716/three-studies-show-how-finerenone-fares-for-nondiabetic-ckd-across-ckd-etiologies
7. Neuen BL, Perkovic V, Agarwal R, et al; FIND-CKD Investigators. Finerenone in patients with chronic kidney disease due to glomerular diseases: a randomized clinical trial. JAMA. 2026;336(3):224-235. doi:10.1001/jama.2026.9923