In chronic kidney disease, the kidneys gradually lose their ability to filter waste from the blood. While diabetes is one of its leading causes, many patients develop the condition because of high blood pressure, autoimmune disorders or other conditions that damage the kidney’s filtering units.
Doctors can slow the disease using medicines that lower blood pressure and newer drugs that lower blood sugar while reducing strain on the kidneys. Yet many patients continue to lose kidney function over time, creating a need for additional treatments that can delay kidney failure.
Beyond diabetes
Now, three global studies published in the New England Journal of Medicine, Journal of the American Medical Association (JAMA), and The Lancet suggest that finerenone, a drug previously used mainly in diabetes-related kidney disease, could help a much broader group of patients.
Across different forms of chronic kidney disease, researchers found that the drug slowed disease progression, reduced protein leakage in urine, and lowered the risk of kidney failure.
“The findings did not come as a complete surprise,” Rajiv Agarwal, an emeritus professor of medicine at Indiana University and a co-author of the studies, said.
Finerenone does not target diabetes itself. Instead, it blocks inflammation and scarring inside the kidneys — processes that can occur in many forms of kidney disease, he added.
The U.S. Food and Drug Administra (FDA) considers finerenone to be a first-in-class drug, meaning it has a “new and unique mechanism of action”.
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U.S. FDA
Evidence across diseases
The first of the three studies, known as FIND-CKD, enrolled 1,584 patients with kidney disease who did not have diabetes. Participants received either finerenone or a placebo in addition to their usual treatment. Researchers found that patients taking finerenone lost kidney function more slowly over nearly three years and were less likely to experience major kidney or heart-related complications.
In another study, researchers focused on more than 900 participants from the FIND-CKD trial who had glomerular diseases, conditions that damage the kidneys’ filtering units and are among the leading causes of kidney failure worldwide. These included IgA nephropathy, an autoimmune disease that damages the glomeruli, as well as focal segmental glomerulosclerosis and membranous nephropathy — two other major causes of kidney failure. Finerenone slowed the worsening of kidney disease, reduced protein leakage in urine by about 42%, and lowered the risk of kidney failure or major loss of kidney function in this group.
The findings suggest finerenone’s benefits extend beyond any single glomerular disease.
“I wouldn’t specifically isolate IgA nephropathy,” Prof. Agarwal said. “Anybody who has glomerulonephritis can use this drug. The alternatives are much more expensive. Some targeted therapies for IgA nephropathy cost $400,000 to $500,000 a year. How many people can afford that?”
Shared pathway
The third study took a broader view. By combining data from FIND-CKD with two earlier finerenone trials, researchers examined whether the drug was working only in certain kidney diseases or targeting a process common to many of them.
Across 14,574 patients, the benefits remained consistent across different causes and stages of kidney disease and in patients with or without diabetes. The consistency suggested finerenone may be acting on a shared pathway involved in kidney damage rather than on any one diagnosis alone.
Beyond the biology, Prof. Agarwal said the findings reflect a broader shift in medicine away from relying on a single drug and towards combination treatment. Much as cancer specialists use multiple medicines together, kidney specialists increasingly combine drugs that target different aspects of disease.
Risks and limits
He cautioned, however, that the findings should not automatically be extended to every kidney disease.
For one, finerenone is not without side effects. The main concern across the studies was hyperkalaemia, or high potassium levels in the blood, which can sometimes trigger dangerous heart rhythm disturbances. About 17% of patients receiving finerenone developed elevated potassium levels but severe cases requiring hospitalisation were uncommon, per Prof. Agarwal.
“The people you won’t treat are the people who have potassium that is above normal,” he said. “So anyone who has potassium more than 5 — you won’t start them on this drug.” He was referring to a blood potassium level of 5 millimoles per litre or higher.
That risk can usually be managed with routine blood tests.
For Indian patients, cost and access may become an important part of the conversation. Finerenone is already available in India and currently costs around ₹80-90 a day, Prof. Agarwal said. However, he said he expected the drug to become significantly cheaper once it loses patent protection in 2028.
But even at current prices, Prof. Agarwal said the costs compare favourably with many other kidney therapies. A patient with diabetes-related kidney disease can receive a full course of modern kidney-protective therapy for less than ₹200 a day in India. Patients without diabetes could potentially be treated for around ₹100 a day, he said.
Detecting the smoke
Yet Prof. Agarwal argued that the larger challenge was not treatment but detection.
The problem may be particularly acute in India, where people appear more genetically susceptible to diabetes and high blood pressure than many Western populations and where the prevalence of both conditions is rising rapidly. Many patients learn they have kidney disease only after substantial damage has already occurred. The growing number of effective therapies, he said, makes early diagnosis more important than ever.
“The people who are really going to make a difference are not the nephrologists but the primary care doctors,” he said.
Patients with diabetes and high blood pressure often spend years under the care of family physicians before ever seeing a kidney specialist. A simple, routine urine test that checks for protein leakage can identify kidney damage at a stage when treatment is most effective.
“We must detect the smoke before it becomes a fire,” he said. The message is especially important now because doctors increasingly have multiple therapies capable of slowing kidney disease once it is detected.
Anirban Mukhopadhyay is a geneticist by training and science communicator from New Delhi.
Published – July 08, 2026 09:00 am IST
