Efficacy and safety of finerenone in patients with chronic kidney disease: an individual participant data pooled analysis (INFINITY).
Publication Title
Lancet
Document Type
Article
Publication Date
6-13-2026
Keywords
Humans; Renal Insufficiency, Chronic; Female; Naphthyridines; Male; Middle Aged; Glomerular Filtration Rate; Mineralocorticoid Receptor Antagonists; Aged; Double-Blind Method; Randomized Controlled Trials as Topic; Treatment Outcome; Cardiovascular Diseases; washington; spokane
Abstract
BACKGROUND: Overactivation of the mineralocorticoid receptor is a common pathway for chronic kidney disease (CKD) progression across multiple disease aetiologies. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has shown kidney and cardiovascular benefits in CKD due to type 2 diabetes, but its efficacy and safety across disease aetiologies, and levels of glycaemia, estimated glomerular filtration rate (eGFR), and albuminuria have not been evaluated. The aim of this study was to evaluate the efficacy and safety of finerenone across the spectrum of CKD.
METHODS: We conducted an individual participant data meta-analysis of three randomised, double-blind, placebo-controlled trials of finerenone in patients with CKD: FIDELIO-DKD (NCT02540993; Sept 17, 2015, to April 14, 2020), FIGARO-DKD (NCT02545049; Sept 17, 2015, to Feb 2, 2021), and FIND-CKD (NCT05047263; Sept 21, 2021, to Feb 2, 2026). We used Cox regression models to evaluate relative effects on kidney and cardiovascular outcomes. The main kidney outcome was kidney failure or sustained 57% or more decline in eGFR; the main cardiovascular outcome was hospitalisation for heart failure or cardiovascular death. This study was registered with PROSPERO, CRD420251269149.
FINDINGS: Across the three trials enrolling 14 574 participants, the mean age was 63·7 years (SD 10·6), 4467 (30·7%) were female, 10 107 (69·3%) were male, mean eGFR was 56·4 mL/min per 1·73 m
INTERPRETATION: In the studied populations with CKD, finerenone reduced the risk of CKD progression, including kidney failure alone, and reduced heart failure hospitalisation, cardiovascular death, and all-cause death. These findings support finerenone as a foundational therapy for CKD across a broad range of disease aetiologies and levels of glycaemia, eGFR, and albuminuria.
FUNDING: Bayer.
Area of Special Interest
Kidney & Diabetes
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Endocrinology
Specialty/Research Institute
Nephrology
Specialty/Research Institute
Cardiology
DOI
10.1016/S0140-6736(26)01009-3
