{"id":"4ffb19897f18","type":"article","url":"https://hartvaat.nl/2026/10/20/finerenone-vermindert-cardiorenale-risicos-bij-ckm-syndroom-overzicht-van-trials/","title":"Finerenone vermindert cardiorenale risico’s bij CKM-syndroom — overzicht van trials en richtlijnen","title_en":"Finerenone: A Non-Steroidal Mineralocorticoid Receptor Antagonist and Its Emerging Role in Cardiovascular-Kidney-Metabolic Syndrome.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Journal of cardiovascular pharmacology","doi":"10.1097/FJC.0000000000001893","source_url":"https://doi.org/10.1097/FJC.0000000000001893","authors":["Kyle G Fischer","Craig J Beavers"],"significance":6,"published":"2026-10-29","source_date":"2026-10-20","image":"https://hartvaat.nl/global/img/6e2cc0469790.webp","kennis":["https://hartvaat.nl/kennis/nierziekte/finerenon-bij-ckd-diabetes/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This narrative review synthesizes evidence for finerenone in cardiovascular-kidney-metabolic (CKM) syndrome, drawing on phase 3 trials including FIDELIO-DKD, FIGARO-DKD, FINEARTS-HF, and the pooled FINE-HEART analysis. Finerenone consistently reduces all-cause mortality (HR 0.91), heart failure hospitalisations (HR 0.83), and kidney composite outcomes (HR 0.80), with recent FIND-CKD data extending benefits to non-diabetic chronic kidney disease. For clinical practice, the review reinforces finerenone’s role as an additive therapy for patients with persistent albuminuria or HFpEF despite maximal renin-angiotensin system inhibition and SGLT2 inhibitors, while addressing practical barriers such as hyperkalaemia monitoring and cost.","created":"2026-10-22T01:15:16Z","updated":"2026-10-22T01:15:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narratieve review vat de rol van finerenone op bij het cardiovasculair-nier-metabool (CKM) syndroom samen, gebaseerd op data uit FIDELIO-DKD, FIGARO-DKD, FINEARTS-HF en de gepoolde FINE-HEART-analyse. Finerenone verlaagt consistent all-cause mortaliteit (HR 0,91), hartfalenhospitalisaties (HR 0,83) en een niercomposiet (HR 0,80), met bijkomende winst aangetoond in niet-diabetische CKD (FIND-CKD). Voor de praktijk bevestigt het artikel de plaats van dit niet-steroïde MR-antagonist als add-on-therapie bij patiënten met persistent albuminurie of HFpEF, ondanks RAS-remming en SGLT2-remmers, en belicht het implementatiebarrières zoals kosten en kaliummonitoring.","abstract_original":"Cardiovascular-kidney-metabolic (CKM) syndrome represents the interconnected pathophysiology of metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease, leading to multiorgan dysfunction and elevated adverse outcomes. Overactivation of the mineralocorticoid receptor (MR), via aldosterone-dependent and ligand-independent pathways, drives inflammation, fibrosis, and oxidative stress and facilitates CKM progression. Finerenone is a selective non-steroidal MR antagonist (nsMRA) that exhibits high MR affinity, has balanced cardiac and renal distribution, and minimal off-target steroidal effects, which make it mechanistically different from steroidal MRAs. Large phase 3 trials such as FIDELIO-DKD and FIGARO-DKD in type 2 diabetes with CKD, and FINEARTS-HF in heart failure (HF) with a left ventricular ejection fraction (LVEF) > 40%, demonstrated consistent cardiorenal benefits. The prespecified FINE-HEART pooled analysis showed finerenone reduced all-cause mortality (HR 0.91, 95% CI 0.84-0.99), HF hospitalizations (HR 0.83, 95% CI 0.75-0.92), and the kidney composite outcome (HR 0.80, 95% CI 0.72-0.90), with benefits consistent across CKM components and background therapies including sodium-glucose cotransporter 2 (SGLT2) inhibitors. Recent data from FIND-CKD extend utility to non-diabetic CKD. Various guidelines incorporate finerenone as an additive therapy for patients with persistent albuminuria on maximal renin-angiotensin system inhibition (RASi) + SGLT2i. This review summarizes the MR pathophysiology in CKM syndrome, compares the mechanisms of non-steroidal versus steroidal MRAs, synthesizes clinical trial evidence, safety, and guideline-directed place in therapy, addresses implementation barriers, including cost, and outlines future research directions. Finerenone may fill a critical gap in multimodal CKM management, enabling comprehensive pillar-based therapy to mitigate residual cardiorenal risk."}