Efficacy and safety of finerenone in patients with chronic kidney disease: an individual participant data pooled analysis (INFINITY).

Summary

An individual participant data meta-analysis of three randomized, double-blind trials (n=14,574) shows finerenone reduces CKD progression (including kidney failure), heart failure hospitalization, cardiovascular death, and all-cause mortality across diverse CKD populations and ranges of glycemia, eGFR, and albuminuria. These findings position finerenone as foundational therapy in CKD beyond diabetes-only indications.

Key Findings

• Across 14,574 CKD participants, finerenone reduced CKD progression, including kidney failure.
• Finerenone lowered the risk of heart failure hospitalization, cardiovascular death, and all-cause mortality.
• Benefits were observed across a broad range of CKD etiologies and across glycemia, eGFR, and albuminuria strata.

Clinical Implications

Consider finerenone as a foundational therapy across CKD phenotypes (in addition to RAS inhibition and SGLT2 inhibitors), particularly in patients at high risk for HF hospitalization or cardiovascular death. Monitor potassium and renal function per MRA best practices.

Limitations

• Heterogeneity across trials and populations may persist despite IPD harmonization
• Industry funding and trial selection may introduce bias; follow-up durations vary across trials

Future Directions

Define optimal sequencing and combination with SGLT2 inhibitors and RAS blockade across CKD etiologies; evaluate effectiveness and safety in underrepresented populations and real-world settings.