Finerenone: Evidence for Benefit in Early Stages of Cardiovascular-Kidney-Metabolic Syndrome

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome is a recently introduced concept that links chronic kidney disease (CKD), cardiovascular disease (CVD), and metabolic risk factors such as obesity or diabetes mellitus (DM). The use of eGFR <60 mL/min/1.73 m² as a CKD indicator often detects more advanced stages of renal disease, even though risk is present at earlier stages, particularly in the presence of albuminuria. SUMMARY: The non-steroidal mineralocorticoid receptor antagonist finerenone has demonstrated efficacy in reducing cardiovascular and renal outcomes in patients with CKD and type 2 DM. Data from FIDELITY, a pooled analysis of FIDELIO-DKD and FIGARO-DKD, showed significant reductions in kidney failure and cardiovascular outcomes in patients with CKD and type 2 DM. Moreover, data from FINEARTS-HF trial revealed that finerenone prevents onset of albuminuric CKD in patients. KEY MESSAGES: These results support a paradigm shift toward earlier intervention in CKM syndrome, with the aim of preserving renal function. Finerenone holds promise for changing the trajectory of CKD within a broader CKM framework. Ongoing trials will further define its role in diverse patient populations and stages of CKM syndrome.