Kidney Week

Abstract: SA-PO0531

Hyperkalemia in Finerenone-Treated Patients with CKD: A FIND-CKD Analysis

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Agarwal, Rajiv, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, United States

Rajiv Agarwal, MD, MS, FASN

• Cherney, David, University Health Network, Toronto General Hospital, University of Toronto,, Toronto, Ontario, Canada

David Cherney, MD, PhD

• Lam, Carolyn S.P., National Heart Centre Singapore, Singapore, Singapore

Carolyn S.P. Lam, MBBS, PhD

• Neuen, Brendon Lange, George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia

Brendon Lange Neuen, MBBS, MS, PhD, FASN

• Perkovic, Vlado, University of New South Wales, Sydney, New South Wales, Australia

Vlado Perkovic, MBBS, PhD, FASN

• Tuttle, Katherine R., Providence Inland Northwest Health, University of Washington School of Medicine, Spokane, Washington, United States

Katherine R. Tuttle, MD, FASN

• Sarafidis, Pantelis, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece

Pantelis Sarafidis, MD, PhD

• Brinker, Meike Daniela, Bayer AG, Wuppertal, Germany

Meike Daniela Brinker, MD, DrMed

• Heerspink, Hiddo Jan L., George Institute for Global Health, University of New South Wales, Sydney, Australia

Hiddo Jan L. Heerspink, PharmD, PhD

Background

In the recent phase 3 FIND-CKD trial, the selective nonsteroidal mineralocorticoid receptor antagonist finerenone reduced the risk of adverse kidney and cardiovascular events in patients with non-diabetic chronic kidney disease (CKD). Finerenone treatment was associated with a predictable and clinically manageable increase in serum potassium concentrations versus placebo. This subanalysis of the FIND-CKD trial investigated the incidence of hyperkalemia overall and by baseline estimated glomerular filtration rate (eGFR).

Methods

Adults with CKD (eGFR, 25 to <90 mL/min/1.73 m²), albuminuria (urinary albumin-to-creatinine ratio [UACR], 200 to ≤3500 mg/g), serum potassium levels ≤4.8 mmol/liter and on optimized renin–angiotensin system blockade were randomized 1:1 to oral finerenone (10 or 20 mg) or matching placebo. Hyperkalemia was defined as an investigator-reported adverse event and serum potassium levels (>5.5 and >6.0 mmol/L) were reported. Data were also analyzed according to baseline eGFR (<60 and ≥60 mL/min/1.73 m²).

Results

Among 1584 patients, investigator-reported hyperkalemia occurred in 135 (17.0%) patients in the finerenone arm and 105 (13.3%) patients in the placebo arm; hyperkalemic events leading to permanent discontinuation occurred in 12 (1.5%) and 1 (0.1%) patients, respectively. Serious investigator-reported hyperkalemia was observed in 8 (1.0%) patients in the finerenone arm and 5 (0.6%) patients in the placebo arm, with 7 (0.9%) and 5 (0.6%) requiring hospitalization, respectively. Serum potassium levels of >5.5 and >6.0 mmol/L were reported in 146/776 (18.8%) and 34/786 (4.3%) of patients in the finerenone arm, and 95/776 (12.2%) and 18/784 (2.3%) in the placebo arm, respectively. Investigator-reported hyperkalemic events were more frequent when eGFR was <60 mL/min/1.73 m² at baseline for both treatment arms (finerenone: 20.8% and placebo: 15.7%) compared with eGFR ≥60 mL/min/1.73 m² at baseline (finerenone: 2.5% and placebo: 3.2%).

Conclusion

There was a modest risk of hyperkalemia with finerenone in adults with non-diabetic CKD. Patients with an eGFR of <60 mL/min/1.73 m² may have an increased risk of hyperkalemia following treatment with finerenone, but rates of permanent treatment discontinuation and serious hyperkalemic events were low in all patients.

Funding

• Commercial Support – Bayer AG