Finerenone, a first-in-class drug previously used for diabetes-related kidney disease, can slow the progression of chronic kidney disease (CKD) across a broad range of patients, regardless of whether they have diabetes. According to three global studies published in the New England Journal of Medicine, JAMA, and The Lancet, the drug reduces protein leakage in urine and lowers the risk of kidney failure by blocking inflammation and scarring.
How does finerenone work for non-diabetic kidney patients?
Finerenone does not target blood sugar. Instead, it blocks the processes of inflammation and scarring inside the kidneys, which are common drivers of damage across various forms of CKD. The U.S. Food and Drug Administration (FDA) classifies it as a first-in-class drug due to its unique mechanism of action.
In the FIND-CKD study, which enrolled 1,584 patients without diabetes, researchers found that those taking finerenone lost kidney function more slowly over nearly three years. These patients also faced a lower risk of major heart-related or kidney complications compared to those given a placebo.
Can it treat autoimmune glomerular diseases?
Yes. A subset of 900 participants from the FIND-CKD trial who suffered from glomerular diseases—conditions that damage the kidney’s filtering units—showed significant improvement. These included IgA nephropathy, focal segmental glomerulosclerosis, and membranous nephropathy.
According to the research, finerenone reduced protein leakage in urine by approximately 42% in this group. Rajiv Agarwal, an emeritus professor of medicine at Indiana University and study co-author, stated that anyone with glomerulonephritis can potentially use the drug.
Cost Comparison: Finerenone vs. Targeted Therapies
Agarwal highlighted a stark contrast in affordability between finerenone and other specialized treatments. While some targeted therapies for IgA nephropathy cost between $400,000 and $500,000 per year, finerenone is far more accessible.
What are the risks and side effects?
The primary concern with finerenone is hyperkalaemia, or abnormally high potassium levels in the blood. This condition can trigger dangerous heart rhythm disturbances. According to Prof. Agarwal, about 17% of patients in the studies developed elevated potassium levels, though severe cases requiring hospitalization were uncommon.
Because of this risk, the drug is not suitable for everyone. Agarwal noted that patients with a blood potassium level of 5 millimoles per litre or higher should not start the medication. However, this risk is typically manageable through routine blood tests.
How does it impact patients in India?
Finerenone is currently available in India, costing roughly ₹80-90 per day. Agarwal expects the price to drop significantly after the drug loses patent protection in 2028.
When combined with other modern kidney-protective therapies, the total daily cost for a patient with diabetes-related kidney disease is less than ₹200. For those without diabetes, the cost could be around ₹100 per day.
Why is early detection still the biggest hurdle?
Despite the availability of drugs like finerenone, many patients only discover their kidney disease after substantial damage has occurred. This is particularly prevalent in India, where genetic susceptibility to high blood pressure and diabetes is high.
Agarwal argues that primary care doctors, rather than nephrologists, are the key to improving outcomes. A simple urine test during a routine visit with a family physician can
