From the Guidelines
Finerenone has not been established as effective for treating non-diabetic proteinuric kidney disease, and its use in this population is not recommended outside of research settings. Currently, finerenone (brand name Kerendia) is FDA-approved specifically for patients with chronic kidney disease associated with type 2 diabetes, as evidenced by the FIDELIO-DKD and FIGARO-DKD trials 1. These trials exclusively studied diabetic patients and demonstrated the efficacy of finerenone in reducing the risk of kidney failure and cardiovascular events in this population. However, there is insufficient evidence supporting its use in non-diabetic proteinuric kidney disease.
For patients with non-diabetic proteinuria and impaired renal function, standard treatment typically includes:
- ACE inhibitors or ARBs as first-line therapy, which have well-established benefits in reducing proteinuria and slowing kidney disease progression regardless of diabetes status.
- Other supportive measures to manage underlying conditions and slow disease progression.
Finerenone works as a non-steroidal, selective mineralocorticoid receptor antagonist that reduces inflammation and fibrosis in the kidneys through different pathways than ACE inhibitors or ARBs, which makes it theoretically interesting for non-diabetic kidney disease, but clinical evidence for this specific population is lacking 1. The most recent and highest quality study, published in 2025, still only supports the use of finerenone in patients with type 2 diabetes and CKD 1. Until clinical trials demonstrate efficacy in non-diabetic kidney disease, finerenone should not be routinely used for this indication outside of research settings, and treatment should focus on established therapies with proven benefits for morbidity, mortality, and quality of life.
From the Research
Efficacy of Finerenone in Non-Diabetic Proteinuria Renal Disease
There is limited direct evidence on the efficacy of finerenone in treating non-diabetic proteinuria renal disease. However, the available studies provide some insights:
- Finerenone has been shown to be effective in reducing proteinuria and improving renal outcomes in patients with diabetic kidney disease 2, 3, 4, 5, 6.
- The mechanism of action of finerenone, as a mineralocorticoid receptor antagonist, suggests that it may also be beneficial in non-diabetic proteinuria renal disease 2, 5.
- However, the current evidence is primarily based on studies in patients with diabetic kidney disease, and more research is needed to confirm the efficacy of finerenone in non-diabetic proteinuria renal disease.
Key Findings
- Finerenone has been shown to reduce proteinuria and improve renal outcomes in patients with diabetic kidney disease 2, 3, 4, 5, 6.
- The FIDELIO-DKD and FIGARO-DKD studies demonstrated that finerenone reduced the composite endpoints of kidney failure and cardiovascular disease in patients with diabetic kidney disease 2, 5.
- The FIONA study is currently investigating the use of finerenone in children with chronic kidney disease and proteinuria, and may provide additional insights into the efficacy of finerenone in non-diabetic proteinuria renal disease 3.
Safety and Tolerability
- Finerenone has been shown to be generally well-tolerated, with a safety profile similar to that of other mineralocorticoid receptor antagonists 2, 4, 5.
- However, hyperkalemia is a potential side effect of finerenone, and patients should be monitored closely for changes in serum potassium levels 2, 5.