Three Papers. Three Journals. One Drug That Could Save Millions of Kidneys

The Rarest Feat in Clinical Research

In the world of medical publishing, dropping a paper in a top journal is hard. Publishing one simultaneously across three of the world’s most prestigious journals — The New England Journal of Medicine, JAMA, and The Lancet — is something that might happen once a decade. That’s exactly what happened this week at the European Renal Association Congress in Glasgow, and the subject isn’t exotic — it’s a drug called finerenone, and its story is one of those paradigm shifts that quietly changes how millions of people will be treated.

The Problem: Kidney Disease Is Everywhere

Chronic kidney disease (CKD) affects roughly 850 million people worldwide — that’s one in ten of us. Most people with CKD don’t have diabetes, yet the only kidney drug with strong evidence for protecting against disease progression was approved specifically for diabetic patients. The other 500+ million non-diabetic CKD patients had virtually no proven treatment.

Think of it this way: if you discovered a fire extinguisher that only worked on one type of fire, and the rest of the building was still burning, you’d want to make it work on everything.

The Mechanism: One Receptor, Many Diseases

Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA). The mineralocorticoid receptor is a protein found in the kidneys and heart. When it gets overactivated — a process called hyperaldosteronism — it triggers inflammation and fibrosis (scarring) in kidney tissue. This happens across many different forms of kidney disease, not just diabetic nephropathy.

The key insight from the research team at The George Institute for Global Health and UNSW Sydney was simple and powerful: if this receptor is driving damage in multiple types of CKD, blocking it should help regardless of the original cause.

The Three Studies

Study 1 — NEJM: Finerenone in Non-Diabetic CKD

Led by Professor Hiddo Heerspink and Professor Vlado Perkovic, the FIND-CKD trial enrolled 1,584 patients with non-diabetic CKD from 24 countries. When finerenone was added to standard care, it:

• Significantly slowed kidney function decline
• Reduced the risk of kidney failure, CKD progression, heart failure, or cardiovascular death by 23%

This was published in The New England Journal of Medicine (DOI: 10.1056/NEJMoa2604625).

Study 2 — JAMA: Finerenone in Glomerular Disease

Led by Associate Professor Brendon Neuen, this study focused on a subset of FIND-CKD patients with glomerular diseases — immune-mediated conditions where the kidney’s filtering units are damaged. For this group, where treatment options have been scarce:

• Reduced kidney failure or CKD progression risk by 26%
• Lowered albuminuria (protein in urine) by 42% at 12 months — a key marker of kidney damage

Published in JAMA (DOI: 10.1001/jama.2026.9923).

Study 3 — The Lancet: The Big Picture — INFINITY Pooled Analysis

Also led by A/Prof Neuen, this mega-analysis pooled data from FIND-CKD with two prior phase III trials in diabetic CKD, covering 14,574 patients across both diabetic and non-diabetic CKD:

• 24% reduction in kidney failure or CKD progression vs. placebo
• 20% reduction in hospitalization for heart failure or cardiovascular death
• 12% reduction in all-cause mortality

These effects were consistent regardless of diabetes status, underlying kidney disease type, or baseline kidney function. Published in The Lancet (DOI: 10.1016/S0140-6736(26)01009-3).

Why This Matters

Let’s put the scale in perspective:

• 850 million people have CKD globally
• It’s already a leading cause of death and disability
• It’s projected to become the fifth largest contributor of premature death by 2040
• Half a billion of those patients don’t have diabetes and had no proven kidney-protective treatment

Finerenone, if expanded beyond its current diabetic indication, could offer kidney and heart protection to hundreds of millions of people who currently have nothing proven.

Safety: It’s Not Risk-Free

Across all three studies, finerenone was generally well tolerated. The main concern was hyperkalemia (elevated blood potassium), which occurred more frequently than with placebo. However, rates of treatment discontinuation and hospitalization due to high potassium were low. This is a manageable side effect — standard potassium monitoring catches it.

The Takeaway

What’s remarkable here isn’t just the individual study results — though a 23-26% risk reduction across multiple CKD subtypes is impressive. It’s the consistency of the signal across three independent analyses, published simultaneously in three different journals, by the same research team. That kind of convergent evidence is as strong as it gets in clinical research.

As A/Prof Neuen put it: “Expanded use of finerenone in patients with CKD has the potential to meaningfully reduce kidney failure and cardiovascular complications for millions of people worldwide.”

This is what good science looks like — not a flashy breakthrough, but a drug that works better than we thought, for more people than we thought, published in the most rigorous way possible.

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Quick Quiz

Q1: What percentage reduction in kidney failure or CKD progression was seen in the pooled INFINITY analysis (14,574 patients)?

Q2: Which three journals published these studies simultaneously?

Q3: What is the main safety concern with finerenone, and is it manageable?

Click to reveal answers


A1: 24% reduction vs. placebo.

A2: The New England Journal of Medicine, JAMA, and The Lancet.

A3: Hyperkalemia (elevated blood potassium). It’s manageable with standard monitoring — treatment discontinuation and hospitalization rates were low.

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Sources: Heerspink HJL et al., NEJM 2026 (DOI: 10.1056/NEJMoa2604625); Neuen BL et al., JAMA 2026 (DOI: 10.1001/jama.2026.9923); Neuen BL et al., The Lancet 2026 (DOI: 10.1016/S0140-6736(26)01009-3). Research from The George Institute for Global Health and UNSW Sydney, presented at the European Renal Association Congress, Glasgow, June 2026.