Finerenone

And what they did was they added finarinone in addition to standard of care, and they compared that to placebo, and they showed that the primary endpoint of that relative change of urine-albumin to creatinine ratio was was decreased by 25% over six months compared with placebo.

And at any time following baseline, 68.1% of participants receiving finerenone achieved a reduction of UACR of at least 30% compared with only 46.6% that received placebo.

And this is also really important because the ADA says that reduction of UACR of 30% is a threshold that it really is significant for slowing CKD progression.

And so this is really a big deal.

It's just that spironolactone is a steroidal mineral corticoid receptor antagonist, while finarinone is non-steroidal.

So in that way, actually, finarinone has less side effects, but you don't want to be using both together.

So if you're using spironolactone for... hypertension, then you know, that's you're not going to also use finerenone.

So I think those are some of the nuances that you know, will be important for people to think about as they're trying to decide what therapy may be best for a given person.

We have SGLT2 inhibitors in diabetes and chronic kidney disease.

We've got finerenone in diabetes and chronic kidney disease.

And the new guidelines have added another treatment, and that is increasing-based therapies, a GLP-1 receptor agonist, again, in patients with type 2 diabetes and other cardiovascular risk factors, another treatment that reduces the risk of developing heart failure.

Fantastic.

The Fineheart analysis was led by Alberto Foi and published in August 2026 in the Journal of the American College of Cardiology.

Why was it needed? Finerenone already has evidence for improving cardiorenal outcomes, but sudden death is often buried inside a larger cardiovascular composite.

Investigators wanted to know whether finerenone might influence this specific mode of death across patients with diabetes, kidney disease, and heart failure.

They pooled participant-level data from three randomized placebo-controlled trials, creating a population of nearly nineteen thousand patients.

The analysis used trial and region-stratified Cox models, and a Fine Gray competing risk analysis accounted for the fact that a patient who dies from another cause can no longer experience sudden death.

Sudden death made up a large portion of cardiovascular mortality.

Finerenone was associated with a lower risk than placebo with a hazard ratio of zero point eight one.

That's a relative reduction of about nineteen percent.