Research ArticleResearchMedication SafetyPatient Education

Finerenone slowed eGFR decline in CKD without diabetes but increased hyperkalemia

The New England journal of medicine (PubMed)Aug 6, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a randomized trial of 1,584 adults with albuminuric chronic kidney disease without diabetes, finerenone slowed the mean annual decline in estimated glomerular filtration rate over 32 months compared with placebo, while hyperkalemia was more frequent.

What NurseJet pulled from the source

Participants were already receiving a renin-angiotensin system inhibitor and received finerenone or placebo. Mean annual eGFR change was -3.3 versus -4.0 mL/min/1.73 m², and the kidney-or-cardiovascular composite was lower with finerenone; hyperkalemia occurred in 17.0% versus 13.3% and led to treatment discontinuation in 1.5% versus 0.1%.

Why this matters for nurses

Nurses and advanced-practice clinicians reconcile renin-angiotensin system therapy, review kidney function and potassium results, teach patients about monitoring, and route medication concerns. The benefit signal is clinically relevant, but safe use depends on an agent-specific surveillance plan.

Bedside takeaway

Pair finerenone with an explicit potassium, kidney-function, interaction, and follow-up plan in CKD without diabetes.

How This Applies in Practice

Use this when: Reconciling, administering, prescribing, or teaching about finerenone for an adult with chronic kidney disease without diabetes.

On your shift

Verify the indication, dose, concurrent renin-angiotensin system therapy, other potassium-affecting medicines, and ordered potassium and kidney-function monitoring.
Use teach-back for the laboratory and follow-up schedule, missed-dose instructions, and symptoms the patient has been told to report.
Escalate elevated potassium, worsening kidney function, a medication interaction, or incomplete required monitoring before proceeding.

Keep in mind: Eligibility and monitoring in the trial were specific, and finerenone is not appropriate for every CKD patient. Follow the medication protocol, facility policy, and provider orders.

Key takeaways

The FIND-CKD trial randomized 1,584 adults without diabetes who had CKD and albuminuria while taking a renin-angiotensin system inhibitor.
Finerenone reduced the mean annual eGFR decline by 0.7 mL/min/1.73 m² compared with placebo.
The hazard ratio for the prespecified composite kidney or cardiovascular outcome was 0.77, with a 95% confidence interval from 0.60 to 0.99.
Hyperkalemia and hyperkalemia-related discontinuation were more frequent with finerenone, making laboratory and medication monitoring central to safe use.

Practice implications

Before administration or medication teaching, reconcile finerenone with other therapies that affect potassium or kidney function and confirm the ordered laboratory schedule. Route elevated potassium, worsening kidney function, missed monitoring, or symptoms of concern to the prescribing team.

Limitations & cautions

The primary outcome was eGFR slope rather than a patient-reported outcome, the cardiovascular component estimate was imprecise, and the trial enrolled a defined albuminuric CKD population already receiving renin-angiotensin system inhibition. The study was funded by Bayer, and results do not establish suitability for patients outside the eligibility criteria.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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The New England journal of medicine (PubMed)

The New England journal of medicine (PubMed). Finerenone in Persons with Chronic Kidney Disease without Diabetes.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42246672/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

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AI-summarized from the linked source. Review the original article before applying to practice.

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Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

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AI-summarized from the linked source. Review the original article before applying to practice.

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During admissions and handoffs, verify the established ventilation, airway-clearance, and cardiac-monitoring plan and coordinate concerns with the multidisciplinary team.

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AI-summarized from the linked source. Review the original article before applying to practice.

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How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

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