A Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter, Event-driven Phase 3 Study to Investigate Efficacy and Safety of Finerenone on the Reduction of Cardiovascular Morbidity and Mortality in Subjects With Type 2 Diabetes Mellitus and the Clinical Diagnosis of Diabetic Kidney Disease in Addition to Standard of Care.
Phase: PHASE3
Conditions: Diabetic Kidney Disease
Sponsor: Bayer

 
Document Type: 
Clinical Study Protocol 
Official Title: 
A randomized, double-blind, placebo-controlled, parallel-group, 
multicenter, event driven Phase III study to investigate the efficacy 
and safety of finerenone on the reduction of cardiovascular 
morbidity and mortality in subjects with type 2 diabetes mellitus and 
the clinical diagnosis of diabetic kidney disease in addition to 
standard of care. 
NCT Number: 
NCT02545049 
Document Date: 
12 MAR 2019 
 

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Cover page of the integrated protocol
A randomized, double-blind, placebo-controlled, parallel-group, multicenter, event-
driven Phase III study to investigate the efficacy and safety of finerenone on the 
reduction of cardiovascular morbidity and mortality in subjects with type 2 diabetes 
mellitus and the clinical diagnosis of diabetic kidney disease in addition to standard of 
care 
This protocol version is an integration of the following documents / sections:
Original protocol, Version 1.0, dated 10 JUN 2015
Amendment 03, (described in Section 15.1)
forming integrated protocol Version 2.0, dated 02 MAY 2017
Amendment 04, (global amendment, refer to the “Protocol amendment 
summary of changes” section) forming integrated protocol Version 3.0, 
dated 12 MAR 2019
Local amendments not forming part of this integrated global protocol:
Amendment 01, (dated 18 AUG 2015)
(local amendment, valid for Japan only)
Amendment 02, (dated 29 JUL 2016)
(local amendment, valid for Turkey only)

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1.
Title page - amended
Study title
A randomized, double-blind, placebo-controlled, parallel-group, multicenter, event-driven 
Phase III study to investigate the efficacy and safety of finerenone on the reduction of 
cardiovascular morbidity and mortality in subjects with type 2 diabetes mellitus and the 
clinical diagnosis of diabetic kidney disease in addition to standard of care
Short title: 
Efficacy and safety of finerenone in subjects with type 2 diabetes 
mellitus and the clinical diagnosis of diabetic kidney disease 
Acronym:                             FIGARO-DKD (FInerenone in reducinG cArdiovascular 
                                             moRtality and mOrbidity in Diabetic Kidney Disease)
Test drug:
Finerenone / BAY 94-8862
Study purpose:
Efficacy and safety
Clinical study phase:
III
Date:
12 MAR 2019
Registration:
EudraCT: 2015-000950-39
Version no.:
3.0
Sponsor’s study no.:
17530 
Sponsor:
Non- US territory: Bayer AG, D-51368 Leverkusen, Germany
US territory: Bayer Healthcare Pharmaceuticals Inc.,
100 Bayer Boulevard, P.O. Box 915, Whippany 
NJ 07981-0915, USA
Sponsor’s medical expert:
Bayer S.A.
04779 900 São Paulo, Brazil
Phone no.: 
The study will be conducted in compliance with the protocol, ICH-GCP and any applicable 
regulatory requirements.
Confidential
The information provided in this document is strictly confidential and is intended solely for 
the guidance of the clinical investigation. Reproduction or disclosure of this 
document - whether in part or in full - to parties not associated with the clinical 
investigation, or its use for any other purpose, without the prior written consent of the 
sponsor is not permitted.
Throughout this document, symbols indicating proprietary names (, TM) may not be displayed. Hence, the 
appearance of product names without these symbols does not imply that these names are not protected.
PPD
PPD

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Signature of the sponsor's medically responsible person 
The signatory agrees to the content of the final clinical study protocol as presented. 
Name: 
On behalf of
Name: 
 
Date: 
Role: 
 
Role: 
 
Signature: 
PPD
PPD
PPD
PPD
PPD
PPD

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Signature of principal investigator
The signatory agrees to the content of the final clinical study protocol as presented.
Name:
Affiliation:
Date:
Signature:
Signed copies of this signature page are stored in the sponsor’s study file and in the respective 
center’s investigator site file.

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2.
Synopsis - amended
This section was changed in Amendment 3, see Section 15.1.2.2.
Title
A randomized, double-blind, placebo-controlled, parallel-group, multicenter, 
event-driven Phase III study to investigate the efficacy and safety of finerenone 
on the reduction of cardiovascular morbidity and mortality in subjects with 
type 2 diabetes mellitus and the clinical diagnosis of diabetic kidney disease in 
addition to standard of care
Short title
Efficacy and safety of finerenone in subjects with type 2 diabetes mellitus and 
the clinical diagnosis of diabetic kidney disease
Acronym
FIGARO-DKD
(FInerenone in reducinG cArdiovascular moRtality and mOrbidity in Diabetic 
Kidney Disease)
Clinical study phase
III
Study objectives
The primary objective of this study is to:

Demonstrate whether, in addition to standard of care (SoC), 
finerenone is superior to placebo in delaying the time to first occurrence 
of cardiovascular (CV) mortality and morbidity in subjects with type 2 
diabetes mellitus (T2DM) and the clinical diagnosis of diabetic kidney 
disease (DKD). 
The secondary objectives of this study are to determine whether, in addition 
to SoC, finerenone compared to placebo:

Delays the time to first occurrence of the following composite endpoint: 
onset of kidney failure, a sustained decrease in estimated glomerular 
filtration rate (eGFR) of ≥40% from baseline over at least 4 weeks or 
renal death

Delays the time to all-cause hospitalization

Delays the time to all-cause mortality

Change in UACR from baseline to Month 4

Delays the time to first occurrence of the following composite endpoint: 
onset of kidney failure, a sustained decrease in eGFR of ≥57% from 
baseline over at least 4 weeks or renal death.
Test drugs
Name of active ingredient Finerenone
Doses

10 mg finerenone tablet once daily (OD) in the morning OR

20 mg finerenone tablet OD in the morning
Route of administration
Oral
Duration of treatment
As an event-driven trial, the actual length of the treatment will depend on the 
observed event rate, the patient recruitment rate, and length of the recruitment 
period and will be between approximately 3.5 and up to 4 years 

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Reference drug
Name of active ingredient Placebo
Dose

Placebo tablet OD in the morning
Route of administration
Oral
Duration of treatment
As an event-driven trial, the actual length of the treatment will depend on the 
observed event rate, the patient recruitment rate, and length of the recruitment 
period and will be between approximately 3.5 and up to 4 years
Background treatment
Standard of care (SoC) therapy
Indication
Diabetic kidney disease (DKD)
Diagnosis and main criteria 
for inclusion /exclusion
Key inclusion criteria:
Men or women ≥18 years of age
T2DM as defined by the American Diabetes Association
Diagnosis of DKD with at least one of the following criteria at Run-in and 
Screening visits:
o persistent high albuminuria 1
OR
o persistent very high albuminuria 2.
Pretreated for at least 4 weeks prior to the Screening Visit with 
either ACEI or ARB at maximal tolerated labeled dose, preferably 
without adjustments to dose or choice of agent or other treatment 
Serum potassium ≤4.8 mmol/L.
Key exclusion criteria:

Confirmed significant non-diabetic renal disease, including clinically 
relevant renal artery stenosis

Uncontrolled arterial hypertension (ie, mean sitting SBP ≥170 mmHg, 
sitting DBP ≥110 mmHg at run-in visit, or mean sitting SBP ≥160 mmHg, 
sitting DBP ≥100 mmHg at screening)

Clinical diagnosis of chronic HFrEF and persistent symptoms 
(NYHA class II – IV) at Run-in visit (class 1A recommendation for MRAs)

Dialysis for acute renal failure within 12 weeks of Run-in visit

Renal allograft in place or scheduled kidney transplant within next 
12 months

HbA1c >12%.
Study design
Randomized, double-blind, placebo-controlled, parallel-group, multicenter, 
event-driven
                                                
1
High albuminuria (previously known as ‘micro-albuminuria’) is defined as 300 mg/g > UACR ≥ 30mg/g in 2 out of 3 first 
morning void samples.
2
Very high albuminuria (previously known as ‘macro-albuminuria’) is defined as UACR ≥ 300mg/g in 2 out of 3 first morning 
void samples.

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Methodology
Randomized subjects will be treated with finerenone or placebo OD in a 
blinded fashion.  The starting dose of study drug will depend on the subject’s 
eGFR level at the Screening Visit: a lower dose of 10 mg OD if eGFR was 
between 25 to < 60 mL/min/1.73m², or the higher (target) dose of 20 mg OD if 
eGFR was ≥60 mL/min/1.73m².  Study drug may be up-titrated from Visit 2 
(Month 1) onwards provided potassium is ≤4.8 mmol/L and eGFR decrease is 
less than 30% below the value last measured.  Down-titration or interruption of 
study drug is permitted at any time during the study for safety reasons.
Type of control
Placebo
Data Monitoring Committee
Yes
Number of subjects
Planned 12800 subjects screened, 6400 subjects randomized
Primary variable
Time to the first occurrence of the composite endpoint of CV death or 
non-fatal CV event (i.e. myocardial infarction, stroke, or hospitalization for 
heart failure)
Time point/frame of 
measurement for 
primary variables
Events for inclusion in the primary variable (above) will be counted from the 
day of randomization (Visit 1) onwards until the End-of-Study (EOS) visit 
following the study termination decision.  In the case of premature termination 
from the study with no subsequent follow-up information, events will be 
counted up to the day of premature termination
Plan for statistical analysis
The log-rank test for the difference of the survival function of finerenone
compared to placebo, stratified by the stratification factors region, type of 
albuminuria, eGFR category and history of cardiovascular disease (CVD) will 
be used, at a two-sided significance level of 5.0% with a small adjustment for 
an interim analysis

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Protocol amendment summary of changes
Amendment 4 (12 MAR 2019)
This amendment is considered to be nonsubstantial based on the criteria set forth in Article 
10(a) of Directive 2001/20/EC of the European Parliament and the Council of the European 
Union because it neither significantly impacts the safety or physical/mental integrity of 
participants nor the scientific value of the study.
Overall Rationale for the Amendment:
This amendment summarizes minor changes in the conduct of the study and planned analyses. 
The main change is that the PT Visit will be performed as a telephone contact for all patients 
except those participating in the iohexol clearance sub-study. The PT Visit is to be performed 
within 4 weeks + 5 days after last study drug intake for those patients still on treatment at the 
EOS Visit (Sections 9.1, 9.2.10, and 9.2.11). The rationale for the change is that a telephone 
call is considered adequate to inquire about possible AEs and concomitant medication usage. 
This change neither compromises patient safety nor scientific value. The performance as a 
telephone contact will minimize the burden on patients, sites, and the sponsor. Procedures that 
would require the presence of the patient at the study site have been adapted accordingly. The 
following activities will no longer be performed: physical examination, ECG, recording of 
body weight and vital signs, and laboratory sampling.
All other minor changes with their brief rationale are summarized in the table below.
Table 1
Protocol amendment summary of minor changes
Section number 
and name
Description of change
Brief rationale
10.1 General 
considerations
10.3.2 Treatment 
duration, extent 
of exposure, up-
titration status 
and compliance
Specification of baseline values.
This was added to clarify the handling of 
subjects who did not immediately start 
with study drug treatment at 
randomization, because all analyses 
follow the intent-to-treat principle.
10.1 General 
considerations
10.3.3.2 Primary 
efficacy variable: 
supportive
For on-treatment efficacy 
analyses, the time window after 
last study drug administration is 
increased from 3 to 30 days.
The time window was increased to better 
reflect the more protracted nature of the 
development and diagnosis of clinical 
outcome events of interest in relation to 
treatment exposure.
continued

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Section number 
and name
Description of change
Brief rationale
10.3.4
Provision of more precise 
wording about the type of 
discontinuation.
Considering the nature of the underlying 
disease and the long duration of the 
study, it is the impact of permanent 
discontinuation of the study drug that is of 
particular interest.
10.3.4.1 Adverse 
events
New definition of treatment-
emergent AEs.
The definition of TEAEs was specified to 
account for permitted study drug 
interruptions (i.e. temporary 
discontinuations) which may occur over 
extended periods.
10.3.4.2 Laboratory 
data
Specification regarding 
interruption of study treatment.
This was updated to consider treatment 
interruptions in a similar manner as done 
for the AE presentation.
10.3.3.5.2 
Decrease in 
eGFR
10.3.4.2 Laboratory 
data
Deletion of the following 
analyses:

Absolute value of serum 
potassium >5.0 mmol/L

Relative decrease from 
baseline in eGFR of ≥25%

Increase from baseline in 
serum creatinine >0.3 mg/dL 
and >0.5 mg/dL
Patients remain on study drug treatment
with potassium values up to 5.5 mmol/L. 
Safety specific information will be 
obtained by analyzing the remaining 
thresholds of >5.5 mmol/L (moderate 
hyperkalemia) and >6.0 mmol/L (severe 
hyperkalemia) for serum potassium.
In this long-term trial relative eGFR 
decrease from baseline ≥25% does not 
provide clinically relevant information. The 
same applies to analyses of change in 
serum creatinine, which is already 
incorporated in the currently planned 
analyses of change in eGFR.
Throughout Section 
10 Statistical 
methods and 
determination of 
sample size
More precise wording.
Specifications changed for correctness.
Where applicable 
Minor editorial and typographical 
errors, updated information on 
responsible persons.
Unsubstantial changes for correctness.

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Table of contents
Cover page of the integrated protocol.................................................................................... 1
1.
Title page - amended.......................................................................................................... 2
Signature of the sponsor’s medically responsible person..................................................... 3
Signature of principal investigator......................................................................................... 4
2.
Synopsis - amended............................................................................................................ 5
Protocol amendment summary of changes............................................................................ 8
Table of contents..................................................................................................................... 10
Table of tables......................................................................................................................... 15
Tables of figures ..................................................................................................................... 15
List of abbreviations............................................................................................................... 16
3.
Introduction..................................................................................................................... 20
3.1
Background.................................................................................................................... 20
3.2
Rationale of the study .................................................................................................... 23
3.3
Benefit-risk assessment.................................................................................................. 24
4.
Study objectives............................................................................................................... 26
5.
Study design - amended................................................................................................... 26
6.
Study population ............................................................................................................. 30
6.1
Inclusion criteria ............................................................................................................ 31
6.2
Exclusion criteria - amended ......................................................................................... 32
6.3
Justification of selection criteria.................................................................................... 33
6.4
Withdrawal of subjects from study................................................................................ 33
Withdrawal ................................................................................................................. 33
6.4.1
6.4.1.1
Discontinuation of study drug - amended ............................................................... 33
6.4.1.2
Discontinuation of study ......................................................................................... 34
Replacement ............................................................................................................... 35
6.4.2
6.4.2.1
Re-screening - amended.......................................................................................... 35
6.4.2.2
Switch over between studies ................................................................................... 36
6.5
Subject identification ..................................................................................................... 36
7.
Treatment(s) .................................................................................................................... 37
7.1
Treatments to be administered....................................................................................... 37
7.2
Identity of study treatment............................................................................................. 37
7.3
Treatment assignment - amended .................................................................................. 38
7.4
Dosage and administration - amended........................................................................... 38
7.5
Blinding ......................................................................................................................... 41
Blinding measures ...................................................................................................... 41
7.5.1
Unblinding - amended ................................................................................................ 41
7.5.2

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Emergency unblinding by the investigator................................................................. 41
7.5.3
7.6
Drug logistics and accountability................................................................................... 41
7.7
Treatment compliance.................................................................................................... 42
8.
Non-study therapy........................................................................................................... 42
8.1
Prior and concomitant therapy....................................................................................... 42
General considerations for prior and concomitant therapy ........................................ 42
8.1.1
Medical management.................................................................................................. 44
8.1.2
Control of blood pressure - amended ......................................................................... 45
8.1.3
Use of potassium supplements and lowering agents .................................................. 45
8.1.4
8.2
Post-study therapy.......................................................................................................... 45
9.
Procedures and variables ............................................................................................... 46
9.1
Tabular schedule of evaluations - amended................................................................... 46
9.2
Visit description - amended ........................................................................................... 50
Run-in Visit (4 to 16 weeks prior to the Screening Visit) - amended ........................ 50
9.2.1
Screening Visit (≤2 weeks prior to Visit 1) - amended............................................. 51
9.2.2
Visit 1 (randomization; Day 1 and baseline) - amended ............................................ 51
9.2.3
Visit 2 (Month 1)........................................................................................................ 52
9.2.4
Visit 3 (Month 4) - amended ...................................................................................... 53
9.2.5
Visit 4, 6, 7, 9, etc. (every 4 months; Month 8, 16, 20, 28, etc., excluding yearly 
9.2.6
visits) - amended......................................................................................................... 53
Visit 5, 8, 11, etc. (every 12 months; Month 12, 24, 36, etc.) - amended .................. 54
9.2.7
Up-titration Visit (4 weeks ± 7 days after up-titration or restart of study drug, 
9.2.8
and for up-titration of study drug) - amended ............................................................ 55
Premature Discontinuation (PD) Visit (as soon as possible but within 7 days 
9.2.9
after study drug is permanently discontinued) - amended.......................................... 56
End of study (EOS) visit - amended........................................................................... 56
9.2.10
Post-Treatment (PT) Visit - amended......................................................................... 57
9.2.11
9.3
Population characteristics .............................................................................................. 58
Demographic .............................................................................................................. 58
9.3.1
Medical history - amended ......................................................................................... 58
9.3.2
9.4
Efficacy - amended ........................................................................................................ 58
Primary efficacy variable............................................................................................ 59
9.4.1
Secondary efficacy variables...................................................................................... 59
9.4.2
Other exploratory efficacy variables .......................................................................... 59
9.4.3
9.5
Pharmacokinetics / pharmacodynamics - amended....................................................... 60
9.6
Safety ............................................................................................................................. 61
Adverse events............................................................................................................ 61
9.6.1
9.6.1.1
Definitions - amended ............................................................................................. 61
9.6.1.2
Classifications for adverse event assessment.......................................................... 62
9.6.1.2.1
Seriousness........................................................................................................... 62
9.6.1.2.2
Intensity................................................................................................................ 63
9.6.1.2.3
Causal relationship............................................................................................... 63
9.6.1.2.4
Action taken with study treatment ....................................................................... 64

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9.6.1.2.5
Other specific treatment(s) of adverse events...................................................... 64
9.6.1.2.6
Outcome............................................................................................................... 65
9.6.1.3
Assessments and documentation of adverse events (AEs) - amended.................... 65
9.6.1.3.1
Event versus outcome .......................................................................................... 66
9.6.1.4
Reporting of serious adverse events (SAEs) - amended ......................................... 67
9.6.1.5
Expected adverse events.......................................................................................... 68
Pregnancies................................................................................................................. 68
9.6.2
9.7
Other procedures and variables...................................................................................... 69
Monitoring of blood potassium - amended ................................................................ 69
9.7.1
Laboratory assessments.............................................................................................. 70
9.7.2
9.7.2.1
Central laboratory.................................................................................................... 70
9.7.2.2
Local laboratory - amended..................................................................................... 71
Physical examination.................................................................................................. 72
9.7.3
Weight, height, hip and waist circumference ............................................................. 72
9.7.4
Measurement of vital signs......................................................................................... 72
9.7.5
Electrocardiogram (ECG) - amended......................................................................... 72
9.7.6
Health-related quality of life (HRQoL) questionnaires.............................................. 72
9.7.7
Planned optional sub-studies ...................................................................................... 73
9.7.8
9.7.8.1
Sub-studies .............................................................................................................. 73
9.7.8.1.1
Echocardiography sub-study - amended.............................................................. 73
9.7.8.1.2
Biomarker sub-study............................................................................................ 76
9.7.8.1.3
Iohexol clearance sub-study - amended............................................................... 76
9.8
Appropriateness of procedures / measurements ............................................................ 77
10. Statistical methods and determination of sample size ................................................. 78
10.1
General considerations................................................................................................... 78
10.2
Analysis sets - amended................................................................................................. 79
10.3
Variables and planned statistical analyses..................................................................... 79
Disposition, baseline, history, demography and medication...................................... 79
10.3.1
10.3.1.1
Disposition - amended............................................................................................. 79
10.3.1.2
Population characteristics........................................................................................ 80
10.3.1.3
Demography and other baseline characteristics - amended .................................... 80
10.3.1.4
Medical history........................................................................................................ 80
10.3.1.5
Concomitant medication ......................................................................................... 80
Treatment duration, extent of exposure, up-titration status and compliance -
10.3.2
amended...................................................................................................................... 81
Efficacy variables ....................................................................................................... 81
10.3.3
10.3.3.1
Primary efficacy variable: primary analysis............................................................ 81
10.3.3.2
Primary efficacy variable: supportive analyses....................................................... 82
10.3.3.3
Secondary efficacy variables: primary analysis...................................................... 83
10.3.3.4
Secondary efficacy variables: supportive analyses ................................................. 83
10.3.3.5
Analysis of other exploratory efficacy variables..................................................... 84
10.3.3.5.1
UACR and albuminuria - amended...................................................................... 84
10.3.3.5.2
Decrease in eGFR ................................................................................................ 84
10.3.3.5.3
Health-related quality of life (HRQoL) ............................................................... 85

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10.3.3.5.4
New diagnosis of atrial fibrillation, new diagnosis of heart failure and 
regression of albuminuria .................................................................................... 85
10.3.3.6
Subgroup analyses................................................................................................... 85
Safety variables........................................................................................................... 86
10.3.4
10.3.4.1
Adverse events ........................................................................................................ 87
10.3.4.2
Laboratory data ....................................................................................................... 87
10.3.4.3
Vital signs................................................................................................................ 88
10.3.4.4
Weight and BMI...................................................................................................... 88
10.3.4.5
Further safety variables ........................................................................................... 88
Missing data / drop outs ............................................................................................. 88
10.3.5
10.4
Determination of sample size - amended....................................................................... 89
10.5
Planned interim analyses - amended.............................................................................. 90
11. Data handling and quality assurance............................................................................ 90
11.1
Data recording................................................................................................................ 90
11.2
Monitoring ..................................................................................................................... 92
11.3
Data processing.............................................................................................................. 92
11.4
Missing data................................................................................................................... 93
11.5
Audit and inspection ...................................................................................................... 94
11.6
Archiving ....................................................................................................................... 94
12. Premature termination of the study .............................................................................. 94
13. Ethical and legal aspects................................................................................................. 95
13.1
Investigator(s) and other study personnel...................................................................... 95
Executive Committee ................................................................................................. 96
13.1.1
Clinical Event Committee (CEC)............................................................................... 96
13.1.2
Data Monitoring Committee (DMC).......................................................................... 97
13.1.3
Steering Committee.................................................................................................... 98
13.1.4
13.2
Funding and financial disclosure ................................................................................... 98
13.3
Ethical and legal conduct of the study........................................................................... 98
13.4
Subject information and consent.................................................................................... 99
13.5
Publication policy and use of data ............................................................................... 100
13.6
Compensation for health damage of subjects / insurance............................................ 101
13.7
Confidentiality ............................................................................................................. 101
14. Reference list.................................................................................................................. 101
15. Protocol amendments.................................................................................................... 106
15.1
Amendment 3............................................................................................................... 106
Overview of changes to the study............................................................................. 106
15.1.1
Changes to the protocol text..................................................................................... 108
15.1.2
15.1.2.1
Section 1 Title page............................................................................................... 109
15.1.2.2
Synopsis ................................................................................................................ 109
15.1.2.3
Section 5 Study design .......................................................................................... 110
15.1.2.4
Figure 5-1 Overall study design............................................................................ 112
15.1.2.5
Section 6.2 Exclusion criteria................................................................................ 113

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15.1.2.6
Section 6.4.1.1 Discontinuation of study drug...................................................... 113
15.1.2.7
Section 6.4.2.1 Re-screening................................................................................. 114
15.1.2.8
Section 7.3 Treatment assignment ........................................................................ 114
15.1.2.9
Section 7.4 Dosage and administration................................................................. 115
15.1.2.10 Section 7.5.2 Unblinding....................................................................................... 116
15.1.2.11 Section 8.1.3 Control of blood pressure................................................................ 116
15.1.2.12 Table 9-1 Study 17530: schedule of activities and evaluations ............................ 117
15.1.2.13 Table 9-2 Sub-studies of Study 17530: schedule of procedures ........................... 119
15.1.2.14 Section 9.2 Visit description ................................................................................. 121
15.1.2.15 Section 9.2.1 Run-in Visit (4 to 16 weeks prior to the Screening Visit)............... 121
15.1.2.16 Section 9.2.2 Screening Visit (≤2 weeks prior to Visit 1).................................... 122
15.1.2.17 Section 9.2.3 Visit 1 (randomization; Day 1 and baseline)................................... 122
15.1.2.18 Section 9.2.5 Visit 3 (Month 4)............................................................................. 123
15.1.2.19 Section 9.2.6 Visit 4, 6, 7, 9, etc. (every 4 months; Month 8, 16, 20, 28, etc., 
excluding yearly visits) ......................................................................................... 123
15.1.2.20 Section 9.2.7 Visit 5, 8, 11, etc. (every 12 months; Month 12, 24, 36, etc.) -
amended ................................................................................................................ 123
15.1.2.21 Section 9.2.8 Up-titration Visit (unscheduled; from 4 weeks ± 7 days 
post-titration)......................................................................................................... 124
15.1.2.22 Section 9.2.9 Premature Discontinuation (PD) Visit ............................................ 124
15.1.2.23 Section 9.2.10 End of study (EOS) visit ............................................................... 124
15.1.2.24 Section 9.2.1 Post-Treatment (PT) Visit............................................................... 125
15.1.2.25 Section 9.3.2 Medical history................................................................................ 125
15.1.2.26 Section 9.4 Efficacy .............................................................................................. 125
15.1.2.27 Section 9.5 Pharmacokinetics / pharmacodynamics ............................................. 125
15.1.2.28 Section 9.6.1.1 Definitions.................................................................................... 126
15.1.2.29 Section 9.6.1.3 Assessments and documentation of adverse events (AEs)........... 127
15.1.2.30 Section 9.6.1.4 Reporting of serious adverse events (SAEs)................................ 127
15.1.2.31 Section 9.7.1 Monitoring of blood potassium....................................................... 127
15.1.2.32 Section 9.7.2.2 Local laboratory ........................................................................... 128
15.1.2.33 Section 9.7.6 Electrocardiogram (ECG) ............................................................... 129
15.1.2.34 Section 9.7.8.1.1 Echocardiography sub-study..................................................... 129
15.1.2.35 Section 9.7.8.1.3 Iohexol clearance sub-study...................................................... 130
15.1.2.36 Section 10.2 Analysis sets..................................................................................... 130
15.1.2.37 Section 10.3.1.1 Disposition ................................................................................. 130
15.1.2.38 Section 10.3.1.3 Demography and other baseline characteristics......................... 131
15.1.2.39 Section 10.3.2 Treatment duration, extent of exposure, up-titration status and 
compliance ............................................................................................................ 131
15.1.2.40 Section 10.3.3.5.1 UACR and albuminuria........................................................... 131
15.1.2.41 Section 10.4 Determination of sample size........................................................... 132
15.1.2.42 Section 10.5 Planned interim analyses.................................................................. 132
15.1.2.43 Section 16.4 Definition of cardiovascular disease (CVD) .................................... 133
15.2
Amendment 4............................................................................................................... 133
16. Appendices..................................................................................................................... 134

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16.1
Guidance on use of common CYP inhibitors or inducers ........................................... 134
16.2
Calculating the Child Pugh score................................................................................. 135
16.3
HRQoL questionnaires ................................................................................................ 135
16.4
Definition of cardiovascular disease (CVD) – new section......................................... 136
Table of tables
Table 1
Protocol amendment summary of minor changes ................................................... 8
Table 7–1 Identity of test drug / finerenone and matching placebo....................................... 38
Table 7–2 Dosage of study drug for administration............................................................... 39
Table 8–1 Dose ranges of ACEIs and ARBs for adults ......................................................... 43
Table 9–1 Study 17530: schedule of activities and evaluations - amended........................... 47
Table 9–2 Sub-studies of Study 17530: schedule of procedures – amended ......................... 49
Table 9–3 Blood potassium: guidance for dose adjustment at Visit 2 and subsequent visits 69
Table 9–4 Central laboratory parameters ............................................................................... 71
Table 9–5 Echocardiography sub-study: biomarkers for evaluation...................................... 74
Table 9–6 Echocardiography sub-study: variables for evaluation ......................................... 75
Table 9–7 Biomarker sub-study: variables for evaluation ..................................................... 76
Table 13–1 Endpoint events to be reported to the Clinical Event Committee (CEC).............. 97
Table 16–1 Cytochrome P450: list of concomitant medication ............................................. 134
Table 16–2 Grading of severity of liver disease (adapted from (56)) .................................... 135
Table 16–3 Classification using the added score from Table 16–2 (adapted from (56))....... 135
Table 16–4 KDQOL-36: grouping of items and description.................................................. 136
Table 16–5 Definition of cardiovascular disease for stratification purposes ......................... 136
Tables of figures
Figure 3–1 Prognosis of CKD by GFR and albuminuria category (3) .................................... 20
Figure 3–2 Approaches to improving outcomes related to DKD (8) ...................................... 21
Figure 3–3 Mechanisms of cardiac and renal damage induced by aldosterone excess (20).... 22
Figure 5–1 Overall study design - amended ............................................................................ 28
Figure 8–1 Background therapy with RAS blockade .............................................................. 43
Figure 9–1 Medical finding during the study: event versus outcome...................................... 66

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List of abbreviations
AASK
African-American Study of Kidney disease and hypertension
ABPI
ankle brachial pressure index
ACEI(s)
angiotensin-converting enzyme inhibitor(s)
AE
adverse event
ANCOVA
analysis of covariance
ALT
alanine aminotransferase
ALTITUDE
Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Disease Endpoints 
AP
alkaline phosphatase
ARB(s)
angiotensin receptor blocker(s)
ARTS
MinerAlocorticoid Receptor Antagonist Tolerability Study
ARTS-DN
MinerAlocorticoid Receptor Antagonist Tolerability Study - Diabetic 
Nephropathy
AST
aspartate aminotransferase
ATC
Anatomical Therapeutic Chemical (classification)
AUC
area under the plasma concentration vs. time curve of total (bound and 
unbound) drug from zero to infinity after single (first) dose
BMI
body mass index
BNP
B-type natriuretic peptide
BP
blood pressure
BSA
body surface area
CEC
Clinical Event Committee
Cmax
maximum total (bound and unbound) drug concentration in plasma after 
single dose administration
CK
creatine kinase
CKD
chronic kidney disease
CKD-EPI
Chronic Kidney Disease Epidemiology Collaboration
CRO
contract research organization
CV
cardiovascular
CVD
cardiovascular disease
CYP
cytochrome P450
CYP3A4
cytochrome P450 isoenzyme 3A4
DBP
diastolic blood pressure
DKD
diabetic kidney disease
DMC
Data Monitoring Committee
DN
diabetic nephropathy
ECG
electrocardiogram 
eCRF
electronic case report form
EED
end expiratory diameter
eGFR
estimated glomerular filtration rate
EOS
End-of-Study (visit)
EQ-5D-5L
EuroQol Group 5-dimension, 5-level questionnaire
ESRD
end-stage renal disease

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EU
European Union
EWDT
E-wave deceleration time
FAS
full analysis set
FDA
Food and Drug Administration
FSH
follicle-stimulating hormone
FU
follow-up
GCP
Good Clinical Practice
GFR
glomerular filtration rate
GGT
gamma glutamyl transpeptidase
GMP
Good Manufacturing Practice
HbA1c
glycated hemoglobin
HDL
high density lipoprotein
HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
HOPE
Heart Outcomes Prevention Evaluation
HRQoL
health-related quality of life
hs-CRP
high-sensitivity C-reactive protein
Hs-TnT
high-sensitivity troponin T
IB
Investigator’s Brochure
ICH
International Conference on Harmonization
IDNT
Irbesartan Diabetic Nephropathy Trial
IEC
Independent Ethics Committee
IR
immediate release
IRB
Institutional Review Board
IVCD
inferior vena cava diameter
IVSd
inter-ventricular septum diameter
IxRS
Interactive Voice / Web Response System
KDIGO
Kidney Disease: Improving Global Outcomes
KDQOL
Kidney Disease Quality of Life
LA
left atrial
LDH
lactate dehydrogenase
LDL
low density lipoprotein
LOS
listing only set
LVED
left ventricular end-diastolic
LVEDD
left ventricular end-diastolic dimension
LVEDV
left ventricular end-diastolic volume
LVEDVi
left ventricular end-diastolic volume index
LVEF
left ventricular ejection fraction
LVESV
left ventricular end-systolic volume 
LVESVi
left ventricular end-systolic volume index
LVM
left ventricular mass
LVMi
left ventricular mass index
MCH
mean corpuscular hemoglobin

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MCHC
mean corpuscular hemoglobin concentration
MCV
mean corpuscular volume
M.D.
doctor of medicine
MedDRA
Medical Dictionary for Regulatory Activities
MI
myocardial infarction
MICRO-HOPE
Microalbuminuria, Cardiovascular, and Renal Outcomes (substudy of the 
HOPE trial)
MR
mineralocorticoid receptor
MRA
mineralocorticoid receptor antagonist
NGAL
neutrophil gelatinase-associated lipocalin
NIDDM
non-insulin dependent diabetes mellitus
NONMEM
non-linear mixed effect modeling
NT-proBNP
N-terminal prohormone B-type natriuretic peptide
NYHA
New York Heart Association
OD
once daily
OPN
osteopontin
PCI
percutaneous coronary intervention
PD
premature discontinuation
PGTV
pressure gradient of tricuspid valve
PIIINP
N-terminal pro-peptide of collagen III
PK
pharmacokinetic(s)
PKS
pharmacokinetic analysis set
PP
polypropylene
PPS
per-protocol analysis set
PR
PR interval in ECG
PT
Post-Treatment (visit)
PWd
posterior wall diameter
QA
quality assurance
RA(A)S
renin-angiotensin(-aldosterone) system
RAP
right atrial pressure
RAVE
electronic data capturing system
RBC
red blood cells
RENAAL
Reduction in Endpoints in NIDDM (non-insulin-dependent diabetes 
mellitus) with the Angiotensin II Antagonist Losartan
RWT
relative wall thickness
SAE
serious adverse event
SAF
safety analysis set
SAP
statistical analysis plan
SAS
Statistical Analysis System
SAVOR-TIMI 53 Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with 
Diabetes Mellitus –Thrombolysis in Myocardial Infarction 53
SBP
systolic blood pressure
SD
study drug
SDv
standard deviation

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SID
subject identification
SMQ
Standardized MedDRA Queries
SoC
standard of care
sST2
soluble suppression of tumorigenicity 2
SUSAR
suspected, unexpected serious adverse reaction
T2DM
type 2 diabetes mellitus
TAPSE
tricuspid annular plane systolic excursion
tmax
time to reach Cmax in plasma after single (first) dose
TEAE
treatment-emergent adverse event
TIA
transient ischemic attack
UACR
urinary albumin-to-creatinine ratio
UAE
urinary albumin excretion
US
United States (of America)
VAS
Visual Analog Scale
VTR
velocity of tricuspid regurgitation
WBC
white blood cells
WHO
World Health Organization

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3.
Introduction
3.1
Background
Diabetic kidney disease (DKD) is the most frequent cause of end-stage renal disease (ESRD) 
in western countries (1). In addition, the risk of cardiovascular (CV) disease and death 
increases in patients with DKD with decreasing glomerular filtration rate (GFR) and 
increasing albuminuria levels (2, 3).
As the type 2 diabetes mellitus (T2DM) population rapidly grows throughout the world within 
the next years (4), and with it the DKD population, there is an increasing need for new 
therapeutic agents that effectively target underlying disease mechanisms and slow or halt the 
progression of kidney disease, whilst also addressing the high CV morbidity and mortality in 
this population.
DKD is a clinical syndrome affecting individuals with diabetes that is characterized by 
albuminuria on at least 2 occasions separated by 3 to 6 months (5). DKD is usually 
accompanied by hypertension, progressive rise in proteinuria, and decline in renal function (3). 
DKD is categorized based on the level of urinary albumin excretion (UAE), either 
high albuminuria (formerly micro-albuminuria, urinary albumin-to-creatinine ratio [UACR] 
30 to < 300 mg/g) or very high albuminuria (formerly macro-albuminuria, UACR ≥ 300 mg/g).
As indicated in Figure 3–1, increased UAE and decreased GFR are both associated with a 
worse prognosis, with an increase in all-cause and CV mortality. Additionally, increased UAE 
and decreased GFR are also risk factors for ESRD, acute kidney injury and progressive CKD, 
independent of each other and of other cardiovascular disease (CVD) risk factors in general as 
well as in high-risk populations (2, 6, 7).
Figure 3–1
Prognosis of CKD by GFR and albuminuria category (3)
GFR = glomerular filtration rate.

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Interventions to improve outcomes related to DKD focus on reducing risk (Figure 3–2), 
including counseling on lifestyle modifications (i.e. smoking cessation and dietary 
modifications to reduce proteinuria and aid in weight loss) and interventions aimed at 
glycemic control, dyslipidemia, and hypertension (8).
Figure 3–2
Approaches to improving outcomes related to DKD (8)
Treatment with renin-angiotensin system (RAS) inhibitors has been of particular interest 
given the ability of these drugs to reduce the rate of progression of renal disease, 
independently and in addition to their antihypertensive effects, as evidenced in the Heart 
Outcomes Prevention Evaluation (HOPE) trial (9), the Reduction of Endpoints in NIDDM 
with the Angiotensin II Antagonist Losartan (RENAAL) trial (10), and the Irbesartan DN 
Trial (IDNT) (11). 
Therefore, angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin-receptor 
blockers (ARBs) can be considered as standard of care (SoC) therapy in patients with DKD 
and are often prescribed to patients with DKD at early stages (8). However, they slow but 
neither halt nor reverse kidney disease progression (12). 
In addition, in placebo controlled studies in patients with early DKD (i.e. patients with high 
albuminuria at baseline), only ACEIs were found to significantly reduce the risk of all-cause 
and CV mortality and morbidity (9). In patients with advanced DKD (i.e. patients with 
decreased kidney function and very high albuminuria at baseline) an impact on overall 
survival has not yet been demonstrated with ARBs (10, 11). ACEIs have not been 
investigated in outcome studies in the advanced DKD population yet. 
Animal studies have shown that aldosterone has an independent role in the development of 
hypertensive kidney disease and vascular injury resulting in myocardial and renal fibrosis 
(Figure 3–3) and its blockade reduces proteinuria (13-16). Long-term RAS blockade with 
ACEIs and ARBs results in incomplete suppression of serum aldosterone levels and is known 
as the ‘aldosterone escape’ phenomenon (17). Exploratory clinical studies in adults have 
shown that in adults with CKD exhibiting the ‘aldosterone escape’ phenomenon, treatment 
CVD = cardiovascular disease; ESRD = end-stage renal disease;
RAAS = renin-angiotensin-aldosterone system.

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with mineralocorticoid-receptor antagonists (MRAs) improves kidney outcomes such as 
proteinuria (18). However, there is also evidence for possible therapeutic utility of 
mineralocorticoid receptor (MR) blockade in conditions of tissue and organ damage with 
normal aldosterone levels (19).
Figure 3–3
Mechanisms of cardiac and renal damage induced by aldosterone excess (20)
The results of several short-term studies support the proposal of Shavit et al. that aldosterone 
should be considered a novel therapeutic renal target in CKD patients with the added potential 
‘off-target’ effects on heart and vasculature (21). Nevertheless, large-scale, long-term 
outcome trials examining whether MRAs can slow progression of kidney disease or prevent 
CV events in this population are missing.
Moreover, the use of currently available steroidal MRAs is known to increase the risk of 
hyperkalemia, particularly in patients with T2DM and decreased kidney function (20, 22).
Finerenone (BAY 94-8862) is a next-generation, oral, selective, non-steroidal MRA. In 
animal models, finerenone reduced cardiac and renal hypertrophy, plasma prohormone of 
brain natriuretic peptide (BNP) and proteinuria more efficiently than in those treated with the 
steroidal MRA eplerenone, when comparing equi-natriuretic doses.  Finerenone’s tissue 
distribution pattern in rats was found to differ from the steroidal MRAs, i.e. spironolactone 
and eplerenone, which showed a higher accumulation of the drug equivalent concentration in 
kidney than in heart tissue, in contrast to finerenone which was found to be equally distributed 
in both the kidney and heart tissue (23).  Steroidal MRAs are known to interfere with the 
steroid hormone receptor, which can cause sexual side effects such as gynecomastia in men.  
However, finerenone is a non-steroidal and selective MRA in vitro, without any detectable 
affinity for the related androgen receptor; sexual side effects are therefore not expected to 
occur with finerenone at therapeutic dose levels.  These characteristics may translate to a drug 
with a positive benefit-risk ratio in patients with DKD.

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In a Phase IIa study, finerenone was studied in individuals with stable HFrEF and mild (eGFR 
60 to < 90 mL/min/1.73 m2) -to-moderate (30–60 mL/min/ 1.73 m2) CKD. In this 
minerAlocorticoid Receptor Antagonist Tolerability Study (ARTS; IMPACT No. 14563, 
NCT01345656), finerenone doses of 2.5 to 10 mg/day safely reduced albuminuria and doses 
of 5.0–10.0 mg/day reduced plasma natriuretic peptides levels to the same magnitude as 
spironolactone 25–50 mg/day. All doses of finerenone were associated with a statistically 
significantly smaller mean increase in serum potassium concentration and clinically 
significantly smaller decreases in eGFR compared to spironolactone (24). 
The MinerAlocorticoid Receptor Antagonist Tolerability Study-Diabetic Nephropathy 
(ARTS-DN; IMPACT No. 16243; NCT01874431) was a multicentre, randomized, 
double-blind, placebo-controlled, parallel-group, Phase IIb study investigating the safety and 
efficacy of several oral doses of finerenone in patients with T2DM and a clinical diagnosis of 
DKD, based on either high albuminuria (UACR 30 to 299 mg/g) or very high albuminuria 
(UACR 300 to 3000 mg/g), and with an estimated glomerular filtration rate (eGFR) of 
30 mL/min/1.73 m2 or more. Finerenone doses of 1.25 mg up to 20 mg once daily (OD) were 
investigated in 823 randomized patients over 90 days of treatment compared to placebo in 
addition to SoC, including a RAS-inhibitor. Finerenone statistically significantly reduced 
albuminuria by 21 to 38%, compared to placebo, at doses of 7.5 mg to 20 mg OD when added 
to RAS blockade. All doses of finerenone were safe and well-tolerated. Incidences of 
treatment-emergent adverse events (TEAEs) were similar between placebo and all finerenone 
dose groups.
Based on the aforementioned properties and initial results of finerenone in Phase II clinical 
trials, finerenone has the potential to address the unmet medical needs in patients with the 
clinical diagnosis of DKD. When added to SoC therapy including a RAS blocker, 10 or 20mg 
finerenone given OD might demonstrate a reduction of CV mortality and morbidity and also 
delay the progression of renal disease compared to placebo in addition to SoC. 
Further details can be found in the latest available version of the Investigator’s Brochure (IB), 
which contains comprehensive information on the study drug.  
In this study (17530), finerenone will be investigated in patients at a high-risk of developing a 
first or recurrent CV event. A second study of the Phase III program of finerenone in DKD, 
Study 16244, will investigate finerenone in patients at high risk of progressing to kidney 
failure and at high risk of CV events. Accordingly, in Study 17530, the primary endpoint will 
focus on CV outcomes whereas in Study 16244, the primary endpoint will focus on renal 
outcomes.
3.2
Rationale of the study
Study 17530 will be the first large-scale, long-term outcome trial examining whether the 
non-steroidal MRA finerenone can decrease CV mortality and morbidity in patients with the 
clinical diagnosis of DKD. Secondary endpoints will focus on renal outcomes, all-cause 
hospitalizations, all-cause mortality and change of UACR. 

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Individuals with T2DM are at significantly increased risk for both CV events and progression 
of kidney disease. High albuminuria is a strong, independent predictor of risk of CVD among 
individuals with diabetes. Moreover, progression of albuminuria in these patients is associated 
with further increase in risk for CVD independent of the initial level of albuminuria. There is 
considerable evidence suggesting that DKD may contribute to the pathogenesis of CVD 
through several pathways including atherosclerosis, myocardial hypertrophy, cardiac fibrosis 
and medial artery calcification (25). The exceptionally high CVD burden in patients with 
T2DM and advanced CKD emphasizes the need for dedicated CV outcome trials in this 
population (26).
Together with Study 16244, which will be the first large-scale, long-term outcome trial 
examining whether finerenone can slow the progression of kidney disease in patients with the 
clinical diagnosis of DKD, Study 17530 is part of the Phase III trial program to evaluate if 
finerenone in addition to SoC can reduce the risk of the major clinical outcomes that affect the 
DKD population.
An inappropriate release of aldosterone contributes to target organ damage found in heart 
failure, myocardial infarction, chronic renal failure and hypertension. The extensive 
expression of the MR in the CV system including the heart, endothelial cells, vascular smooth 
muscle cells and kidney mesangial cells gives further evidence for the role of aldosterone in 
CV and renal injury.
Blockade of the action of aldosterone and potentially other MR ligands such as cortisol has 
been demonstrated to be of benefit in different forms of CVD (27-29).  Results from several 
short-term studies show that treatment with MRAs in addition to RAS blockade with an ACEI 
or ARB improves albuminuria; however, long-term outcome trials examining whether MRAs 
can prevent CV events or slow progression of kidney disease in a diabetic or non-diabetic 
CKD population are still lacking. The Phase III program with finerenone in DKD will be the 
first program addressing both questions: Study 17530 will investigate the effects of the 
non-steroidal MRA finerenone on CV outcomes and Study 16244 the effects of finerenone on 
renal outcomes. 
The actual mechanisms behind the pathological effects of aldosterone in DKD have not yet 
been fully elucidated; however, aldosterone seems to be a key player in the progression of 
kidney disease, and also contributes to the accompanying high CV morbidity and mortality of 
these patients. Potent and selective MR blockade with finerenone may therefore provide 
protection against the burden of CVD and also slow or halt the progression of kidney disease 
in the targeted DKD population. 
3.3
Benefit-risk assessment
In this study, Study 17530, subjects with T2DM and DKD at high risk for a first or recurrent 
CV event will be given oral doses of 10 mg or 20 mg finerenone or placebo OD, in addition to 
SoC practice. 
Among patients with diabetes, those with kidney disease are consistently observed to have 
substantially elevated mortality rates. Much of this mortality is due to CVD, although non-CV 

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mortality is also increased. Albuminuria and eGFR are independently and additively 
associated with increased risks of CV events, CV mortality, and all-cause mortality (25). 
There is a high unmet medical need for treatments that can reduce the extensive burden of 
CV mortality and morbidity and the progression of kidney disease in patients with DKD.
The population for Study 17530 has been chosen to adequately define a study population at 
high risk of developing CV events. Amongst individuals with T2DM, increased levels of 
albuminuria and decreased eGFR are both independently and synergistically associated with 
increased risk of CV death as well as CV events, compared to those without CKD 
manifestations (2, 30). Towards the upper end of the high albuminuria category 
(30 to < 300 mg/g), the adjusted risk of CV mortality is more than twice that of the risk in 
individuals with normal albuminuria (31).  Patients with very high albuminuria and still 
preserved eGFR (≥60 mL/min/1.73 m2) have also a high risk of CV events (32) and will also 
be included in this study.
The presence of albuminuria in an individual is highly predictive of CV events and 
progression of kidney disease.  In ARTS-DN (study 16243) in patients with T2DM and DKD 
treated with finerenone in combination with SoC therapy using a RAS inhibitor, a 
dose-dependent reduction in UACR from baseline to Day 90 was demonstrated.  Statistically 
significant reductions in UACR of 21%, 25%, 33% and 38% at Day 90 compared to baseline 
were observed for the 4 highest doses of finerenone (7.5, 10 mg, 15 mg, and 20 mg od, 
respectively) compared to placebo.  In a post hoc analysis, UACR decreases of ≥ 30% from 
baseline to Day 90 in the placebo, 7.5 mg, 10 mg, 15 mg and 20 mg groups were seen for 
23.9%, 40.2%, 46.0%, 51.3% and 62.5% of subjects, respectively, and UACR decreases of 
≥50% in the same groups were seen for 13.6%, 17.2%, 17.2%, 33.6% and 40.2% of subjects, 
respectively.  Post-hoc analyses of randomized clinical trials (33, 34) suggest that a meaningful 
reduction in albuminuria may translate to protection from CV events and declining renal 
function in patients with diabetic and non-diabetic renal disease with albuminuria.  For every 
30% reduction in albuminuria, the risk of ESRD decreased by 23.7% (95% confidence interval, 
11.4% to 34.2%; p=0.001) (33); there was an 18% reduction in CV risk and 27% reduction in 
HF risk for every 50% reduction in albuminuria (34).
The main risks identified from previous studies with steroidal MRAs are the development of 
hyperkalemia and worsening of renal function.  The risk for such adverse events (AEs) with 
finerenone is not ruled out.  However, in ARTS-DN, the incidence of hyperkalemia was low, 
and the incidence of eGFR decline ≥30% relative to baseline was similar between placebo and 
finerenone groups, with no imbalance in reported AEs related to the MedDRA primary 
system organ class ‘Renal and urinary disorders’. In ARTS (study 14563), all doses of 
finerenone resulted in significantly lower potassium increase and less eGFR reduction 
compared to spironolactone.
Thus, potassium levels and renal function will be closely monitored in this study. 
To minimize safety risks to the patient, starting doses of study medication will be chosen 
according to baseline renal function, and subsequent dose up-titration will be performed on 
the basis of measured potassium and eGFR values.  A 2-step up-titration is consistent with 
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to up-titrate the drug only if tolerated in order to avoid adverse effects on potassium and renal 
parameters. Stopping rules for temporary and permanent discontinuation or dose reduction of 
study drug based on potassium values will minimize the risk of hyperkalemia. At any time 
during the study, the investigator has the option to also down-titrate the study drug, depending 
on serum potassium and the progression of the underlying disease.  
All protocol-related procedures, including vital signs measurements, 12-lead electrocardiograms 
(ECGs), echocardiography and blood and urine sampling, are non-invasive or established 
routine assessments in the management of patients with DKD with or without CVD. 
The high risk for CVD and progression of kidney disease in the study population of 
Study 17530, taken together with the beneficial results of MRAs on CVD in previous clinical 
trials and the results of finerenone in the Phase II studies all point towards a positive risk-
benefit assessment that is in favor of the participation of subjects in this study.
4.
Study objectives
The primary objective of this study is to:

Demonstrate whether, in addition to standard of care (SoC), finerenone is superior to 
placebo in delaying the time to first occurrence of cardiovascular (CV) mortality and 
morbidity in subjects with T2DM and the clinical diagnosis of DKD. 
The secondary objectives of this study are to determine whether, in addition to SoC, 
finerenone compared to placebo:

Delays the time to first occurrence of the following composite endpoint:
onset of kidney failure, a sustained decrease in eGFR of ≥40% from baseline over at 
least 4 weeks, or renal death

Delays the time to all-cause hospitalization 

Delays the time to all-cause mortality

Reduces UACR from baseline to Month 4 

Delays the time to first occurrence of the following composite endpoint:
onset of kidney failure, a sustained decrease in eGFR of ≥57% from baseline over 
at least 4 weeks or renal death.
5.
Study design - amended
This section was changed in Amendment 3, see Section 15.1.2.3.
Design overview
Study 17530 is a randomized, double-blind, placebo-controlled, parallel-group, multicenter, 
event-driven Phase III study. Figure 5–1 displays the overall study design.
Patients from approximately 900 study centers worldwide will be randomized in a 1:1 ratio to 
either finerenone or placebo in addition to SoC therapy. Assuming a screening failure rate of 

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approximately 50%, 12800 patients will have to be screened to randomize approximately 
6400 patients. 
The anticipated duration of the study is approximately 4 up to 4.5 years: this includes an 
anticipated recruitment period of approximately 2.75 to up to 3.5 years followed by a study 
drug treatment period of approximately 11 and 7 months, respectively, after the enrolment of 
the last patient into the trial and a maximum of 4.5 months for the run-in and screening period 
and 1 month for the follow-up. However, as an event-driven trial, the actual length of the trial 
will depend on the observed event rates, the patient recruitment rate, and length of the 
recruitment period. 
Since all randomized subjects belong to the Full Analysis Set (FAS) on which the efficacy 
analyses are based, it is important to avoid randomization of non-eligible subjects into the study.
Run-in Period (4 up to 16 weeks)
Subjects with written informed consent who complete the Run-in Visit and meet all
eligibility3 criteria will be enrolled into a mandatory Run-in Period, the purpose of which is to 
ensure that the subject’s SoC therapy including treatment with ACEIs or ARBs is optimized 
and that all inclusion and exclusion criteria are met at the Screening Visit. The Run-in Period 
will last for a minimum of 4 weeks and a maximum of 16 weeks.
In the absence of documentation of diagnosis of high or very high albuminuria (see Section 3.1
for definition), the subject may still be enrolled into the study as albuminuria will be 
measured at the Run-in Visit; in this case, the Run-in Period must last for a minimum of 
12 weeks and a maximum of 16 weeks.
Screening Period (up to 2 weeks)
At the end of the Run-in Period, a Screening Visit to confirm the subject’s eligibility will take 
place within ≤ 2 weeks prior to the planned randomization. At this visit, it will be assessed 
whether the subject still meets all the inclusion and none of the exclusion criteria.3
For those subjects without a prior documented diagnosis of high or very high albuminuria, the 
Screening Visit must be performed at least 12 weeks after the Run-in Visit, and albuminuria 
should then be re-evaluated. If the subject still suffers from high or very high albuminuria 
whilst on SoC treatment, and fulfills all other eligibility criteria, she/he can be randomized 
into the study.
                                                
3 Eligibility criteria related to central laboratory evaluation will be assessed once results are available.

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Figure 5–1
Overall study design - amended

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Treatment Period
Eligible subjects will be randomized to receive once daily (OD) oral doses of finerenone 
(10 mg or 20 mg) or placebo in addition to their SoC therapy.
There will be up to 4 planned visits (including randomization at Visit 1) in the first 4 months; 
thereafter visits will take place every 4 months until the end of the study. Study drug dose can 
be up-titrated from Visit 2 (Month 1) onwards or down-titrated at any point (even between 
scheduled visits); guidance on dose adjustment is provided in Section 7.4.  Subjects may be 
seen at any time throughout the study, in addition to scheduled visits, at the discretion of the 
investigator. 
It is planned that all randomized subjects will remain in the trial until either: 
a.
the projected number of primary endpoints (see Sections 9.4.1 and 10.4) is reached, or 
b. the trial is terminated prematurely at the recommendation of the independent Data 
Monitoring Committee (DMC) (see Section 13.1.3). 
All randomized subjects, including any subject who experienced a health event considered for 
the pre-specified primary or secondary endpoints, should continue to receive study drug until 
the trial is completed (see definition for end of study below) provided there are no safety 
grounds for discontinuing treatment.
Discontinuation of study drug (for any reason) does not constitute the subject’s withdrawal 
from the study, except if the investigator believes that it is in the best interest of the subject or 
if the subject withdraws consent (see Section 6.4.1 for details).  
Details on procedures that are important to ensure the safety of the individual study subject 
are provided in the relevant sections of this protocol (i.e. medical management, control of 
blood pressure and use of potassium supplements/lowering agents in Section 8.1, and 
monitoring blood potassium in Section 9.7.1). 
Follow-up Period
The period between the subject’s last intake of study drug and last visit in the study is referred 
to as the ‘Follow-up Period’. If a subject withdraws from study drug permanently but does 
not withdraw from the study, this would apply to the period between the Premature
Discontinuation (PD) Visit, which should take place as soon as possible following permanent 
discontinuation of study drug, and the EOS Visit. In the case where a subject discontinues 
treatment at the EOS Visit, the Follow-up Period applies to the period between the EOS visit 
and PT visit.
All subjects who withdraw consent can be followed up for vital status if they do not sign the 
‘Declaration of Objection’ form. In addition, vital status can be obtained by the investigator 
from publicly available data sources. The collection of vital status must be obtained within the 
timelines provided by Bayer.

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End of study
The end of the study as a whole will be reached as soon as the last visit of the last subject of 
Study 17530 has been reached in all centers in all participating countries (EU and non-EU).
The study will terminate either when:
(1) the targeted number of primary efficacy endpoint events have been positively adjudicated
OR
(2) at a recommendation of the DMC, whichever is earlier.
After notification of study termination, for all subjects still participating in the study, 
an End-of-Study (EOS) Visit should be scheduled as soon as possible (within 4 weeks of 
notification at the latest) to determine whether the subject had an event for inclusion in the 
primary or secondary endpoints.
Subjects who are still on treatment will discontinue study drug treatment at the EOS Visit and 
must perform the Post-Treatment (PT) Visit (4 weeks + 5 days) after their last dose of study drug.
The primary completion event for this study is the last visit for the last subject.
The primary completion date for this study according to the FDA Amendment Act is specified 
in a separate document (not part of this study protocol).
6.
Study population
Subjects with T2DM and a clinical diagnosis of DKD treated with the individual maximum 
tolerated labeled dose of either an ACEI or an ARB (but not both), who meet all the inclusion 
criteria and none of the exclusion criteria will be eligible for enrollment in this study. Subjects 
switching over from Study 16244 to this study at the Screening Visit must only meet all the 
inclusion criteria and none of the exclusion criteria at the Screening Visit to be eligible for 
enrollment in this study (17530). 

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6.1
Inclusion criteria
Subjects must meet all of the following inclusion criteria to be included in the study:
1. Written informed consent signed before any study-specific procedure
2. Men or women aged 18 years and older. The lower age limit may be higher if legally 
required in the participating country.
3. Women of childbearing potential can only be included in the study if a pregnancy test is 
negative at the screening visit and if they agree to use adequate contraception. 
Adequate contraception is defined as any combination of at least 2 effective methods of 
birth control, of which at least one is a physical barrier (e.g. condoms with hormonal 
contraception or implants or combined oral contraceptives, certain intrauterine devices). 
Women are considered post-menopausal and not of child-bearing potential if they have 
had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile 
(e.g. age appropriate) or 6 months of spontaneous amenorrhea with serum FSH levels 
> 40 mIU/mL [for US only: FSH levels > 40 mIU/mL and estradiol < 20 pg/mL] or have 
had surgical treatment such as bilateral tubal ligation, bilateral ovarectomy, or 
hysterectomy.
4. Subjects with type 2 diabetes mellitus as defined by the American Diabetes Association (35)
5. Subjects with a clinical diagnosis of DKD based on either of the following criteria at the 
Run-in and Screening Visit:

Persistent high albuminuria defined as UACR of 30 mg/g (3.4 mg/mmol) 
but < 300 mg/g (< 33.9 mg/mmol) in 2 out of 3 first morning void samples and 
eGFR 25 but ≤90 mL/min/1.73 m2 (CKD-EPI) (36, 37)4
OR

Persistent very high albuminuria defined as UACR of ≥300 mg/g (≥33.9 mg/mmol) in 
2 out of 3 first morning void samples and eGFR ≥60 mL/min/1.73 m2 (CKD-EPI) (36, 
37)
Note: One re-assessment of eGFR and UACR is allowed at the Run-in Visit and the 
Screening Visit. If one of the 3 UACR measurements is missing but the other 
2 are valid, these values can be used to assess subject’s eligibility for this study.
6. Prior treatment with ACEIs and ARBs as follows:

For at least 4 weeks prior to the Run-in Visit, subjects should be treated with 
either an ACEI or ARB, or both

Starting with the Run-in Visit, subjects should be treated with only an ACEI or ARB
                                                
4
Note: The number of subjects with eGFR ≥ 60 and high albuminuria will be capped at approximately 10% of 
the total population with high albuminuria at screening.

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
For at least 4 weeks prior to the Screening Visit, subjects should be treated with the 
maximum tolerated labeled dose (but not below the minimal labeled dose) of only an 
ACEI or an ARB (not both) preferably without any adjustments to dose or choice of 
agent or to any other antihypertensive or antiglycemic treatment (see Section 8.1).
7. Serum potassium ≤4.8 mmol/L at both the Run-in and the Screening Visit 
Note: One re-assessment of potassium is allowed at the Run-in and the Screening Visit.
8. Ability to understand and follow study-related instructions.
6.2
Exclusion criteria - amended
This section was changed in Amendment 3, see Section 15.1.2.5.
Subjects who meet any of the following criteria will be excluded from the study:
Medical and surgical history
1. Known significant non-diabetic renal disease, including clinically relevant renal artery 
stenosis 
2. UACR > 5000 mg/g (> 565 mg/mmol) at the Run-in Visit or Screening Visit
Note: One re-assessment is allowed in case UACR is > 5000 mg/g in one of the three 
urine samples collected at the Run-in Visit and the Screening Visit.
3. HbA1c > 12% (> 108 mmol/mol) at the Run-in Visit or Screening Visit
4. Uncontrolled arterial hypertension with mean sitting systolic blood pressure (SBP) 
170 mmHg or mean sitting diastolic blood pressure (DBP) 110 mmHg at the 
Run-in Visit or mean sitting SBP 160 mmHg or mean sitting DBP 100 mmHg at the 
Screening Visit
5. Mean SBP < 90 mmHg at the Run-in Visit or at the Screening Visit
6. Subjects with a clinical diagnosis of chronic heart failure with reduced ejection fraction 
(HFrEF) and persistent symptoms (New York Heart Association class II - IV) at the 
Run-in Visit (class 1A recommendation for MRAs)
7. Stroke, transient ischemic cerebral attack, acute coronary syndrome, or hospitalization for 
worsening heart failure, in the last 30 days prior to the Screening Visit
8. Dialysis for acute renal failure within 12 weeks prior to the Run-in Visit
9. Renal allograft in place or a scheduled kidney transplant within the next 12 months from 
the Run-in Visit 
10. Known hypersensitivity to the study treatment (active substance or excipients)
11. Addison’s disease
12. Hepatic insufficiency classified as Child-Pugh C (see Section 16.2).

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Medication and drug use
13. Concomitant therapy with eplerenone, spironolactone, any renin inhibitor, or 
potassium-sparing diuretic which cannot be discontinued at least 4 weeks prior to the 
Screening Visit
14. Concomitant therapy with both ACEI and ARBs which cannot be discontinued for the 
purpose of the study 
15. Concomitant therapy with potent cytochrome P450 isoenzyme 3A4 (CYP3A4) inhibitors or 
inducers (to be stopped at least 7 days before randomization) (see Section 16.1).
Other
16. Any other condition or therapy, which would make the subject unsuitable for this study 
and will not allow participation for the full planned study period (e.g. active malignancy 
or other condition limiting life expectancy to less than 12 months)
17. Pregnant or breast-feeding or intention to become pregnant during the study
18. Previous assignment to treatment during this study or Study 16244
19. Previous (within 30 days prior to randomization) or concomitant participation in another 
clinical study (i.e. Phase I-III clinical studies) with investigational medicinal product(s), 
except for participation in the Run-in and Screening period of Study 16244 (see also 
details on switch over in Section 6.4.2.2)
20. Close affiliation with the investigational site; e.g. a close relative of the investigator, 
dependent person (e.g. employee or student of the investigational site).
6.3
Justification of selection criteria
The selection criteria were chosen to adequately define a DKD study population at high risk 
of developing CV events, and to exclude subjects from the study who may potentially be 
exposed to particular risks after study drug administration and subjects with conditions that 
may have an impact on the aims of the study.
6.4
Withdrawal of subjects from study
Withdrawal
6.4.1
6.4.1.1
Discontinuation of study drug - amended
This section was changed in Amendment 3, see Section 15.1.2.6.
After randomization, discontinuation of study drug (for any reason) does not constitute the 
subject’s withdrawal from the study (see also Section 6.4.1.2).
Study drug must be permanently discontinued if any of the following occurs:

Pregnancy of the study subject (see also Section 9.6.2)

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
The investigator is of the opinion that continuation of treatment with study drug is 
harmful to the subject’s well-being

The randomization code is broken by the investigator, or other responsible person, 
when knowledge of the subject’s treatment is required

Any investigational drug other than the study drug is used.
Study drug may be permanently discontinued if any of the following occurs:

Any suspected drug-related AE or SAE

If any exclusion criterion applies during treatment

If a significant violation of the protocol occurs, as defined by the sponsor and the 
coordinating investigator.
In general, subjects who permanently discontinue study drug are expected to continue in the 
follow-up period and to attend all protocol-specified study visits, and should be encouraged to 
perform all assessments described in the visit schedule (see Section 9.2).
If a subject no longer on study drug is unable to attend the clinic for a study visit, a 
telephone consultation may be performed to determine if relevant health events / endpoints 
(e.g. development of CV or renal complications) have occurred. Ideally, a face-to-face visit 
should be performed at least once a year. Expected frequency of telephone contacts should be 
in line with the standard visit schedule, and therefore performed every 4 months. Ad hoc 
additional telephone contacts may also be requested (e.g. prior to the interim analysis) and 
made to the subject themselves or to other contact as provided by the patient, e.g. a next of 
kin, primary physician (or local equivalent). 
Note that study drug may be temporarily discontinued (i.e. interrupted), as described in 
Section 7.4.
6.4.1.2
Discontinuation of study
Subjects must be withdrawn from the study if the following occurs:

At their own request or at the request of their legally acceptable representative. 
At any time during the study and without giving reasons, a subject may decline to 
participate further. The subject will not suffer any disadvantage as a result (see also 
Section 13.4).
Subjects may be withdrawn from the study if either of the following occurs:

If, in the investigator's opinion, continuation of the study would be harmful to the 
subject’s well-being 

At the specific request of the sponsor and in liaison with the investigator.
Should a subject withdraw consent to participate in the study, he/she may either:

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
Agree to continue releasing information for the study (for details, see Section 9.1),
or

Refuse to allow further release of information.
Depending on the time point of withdrawal: 

A subject who discontinues study participation prematurely for any reason is defined 
as ‘dropout’ if the subject has already been randomized

A subject who, for any reason (e.g. failure to satisfy the selection criteria), terminates 
the study before randomization is regarded as a ‘screening failure’.
General procedures
In all cases, the reason for withdrawal of study drug and/or of study participation must be 
recorded in the eCRF and in the subject’s medical records.
As specified in Section 13.4, the subject may object to the generation and processing of 
post-withdrawal data.
Details for the premature termination of the study as a whole (or components thereof) are 
provided in Section 12.
Replacement
6.4.2
Randomized subjects who withdraw prematurely will not be replaced.
If applicable, a subject who is not eligible at the Run-in or Screening Visit may be re-screened 
at a later time (see Section 6.4.2.1) or switch over to Study 16244 (see Section 6.4.2.2) 
provided the pre-requisites are met.
6.4.2.1
Re-screening - amended
This section was changed in Amendment 3, see Section 15.1.2.7.
If a subject is not eligible at the Run-in or Screening Visit for either this study (17530) or 
Study 16244, the subject may be re-screened at a later time.
The following conditions are pre-requisites of re-screening:

Before re-screening, new written informed consent must be obtained

Allocation of a new subject identification number 

All assessments for the study must be repeated

A minimum of 3 months between the initial Run-in Visit and re-screening.
A subject may be re-screened only once and after being declared as a screening failure.  
During re-screening, a switch over between studies is allowed (see Section 6.4.2.2).

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6.4.2.2
Switch over between studies
DKD is a disease continuum characterized by 2 highly variable parameters, eGFR and UACR. 
The thresholds of these parameters for these studies (17530 and 16244) were chosen in order 
to define a high risk population.  It should be noted these parameters may vary in daily life 
making the patient eligible for one or the other study.  Nevertheless, these variations still reflect 
the disease continuum and do not alter the high risk. The reason for allowing switch over is to 
account for these intrinsic variations.  In addition, it also serves the purpose of reducing the 
burden on the subjects due to not needing to repeat the run-in and screening assessments.  
Subjects are permitted to switch from Study 17530 to Study 16244, or vice versa. 
A switch over from either study is permitted only once and should take place during the 
respective Run-in and Screening periods.
An example is as follows:
If a subject initially enrolled in Study 17530 is found to be not eligible during the Run-in 
or Screening Period of Study 17530, the investigator may consider enrolling this subject 
into Study 16244 if the subject meets the eligibility criteria at run-in or screening for 
Study 16244. Prior to the subject being enrolled in Study 16244, the subject must provide 
written informed consent.
The subject will be transferred to Study 16244 in the IxRS system as outlined in the 
Investigator Guide. The subject will continue with their originally assigned subject 
identification (SID) into Study 16244. Within the SID, the study identifier will indicate 
the subject has switched from Study 17530 to Study 16244 (see Section 6.5). The 
procedures and assessments from the Run-in and/or Screening Visit(s) of Study 17530 do 
not have to be repeated for Study 16244; the data, including laboratory data, will be 
transferred from Study 17530 to Study 16244.

If a subject switches from Study 17530 to Study 16244 in the Run-in period but is found 
not to meet the in- and exclusion criteria of Study 16244 at the end of the Screening Period, 
this subject is not permitted to switch back into Study 17530 and must be registered as a 
screening failure of study 16244. If this is the case, the subject may still be re-screened for 
either of the studies if he or she fulfills the criteria mentioned in Section 6.4.2.1.
6.5
Subject identification
Upon signing the informed consent form and registering the subject in IxRS, each subject will 
automatically be assigned a unique 9 digit subject identification (SID) number by the IxRS for 
unambiguous identification throughout the study.  The SID number is constructed as follows:
Digits 1 - 2:
Unique country number
Digits 3 - 5:
Study center number, unique within any country
Digit 6:
Study-specific identifier
Digits 7 - 9:
Subject number, unique within any study center of a given country for the study.

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7.
Treatment(s)
7.1
Treatments to be administered
Finerenone immediate-release (IR) tablets are light orange film-coated tablets, oval 
(modified oblong), containing 10 mg or 20 mg finerenone (Table 7–1). Matching placebo 
tablets will be supplied.
Following a Screening Visit, eligible subjects will be randomized 1:1 to either finerenone or 
placebo, and study drug will be dispensed according to the visit schedule (see Section 9.1).
The subject will receive the following:

Finerenone
−10 mg finerenone tablet once daily (OD)
(starting dose for subjects with an eGFR between 25 to < 60 mL/min/1.73m² at the 
Screening Visit) 
−20 mg finerenone tablet OD
(starting dose for subjects with an eGFR ≥60 mL/min/1.73m² at the Screening Visit) 
or

Placebo tablet OD. 
Following randomization of the subject, the IxRS will determine the bottle number for the 
study site investigator or designee to select for the subject. The investigator at the study site is 
to instruct subjects to take 1 tablet OD, preferably in the morning. The first dose of study drug 
should be taken at the site on the same day as Visit 1 (Day 1), preferably in the morning.
7.2
Identity of study treatment
Details (e.g. composition, formulation) of the study drug are provided in Table 7–1. 
All study drugs will be labeled according to the requirements of local law and legislation. 
Label text will be approved according to the sponsor’s agreed procedures, and a copy of the 
labels will be made available to the study site upon request.
For all study drugs, a system of numbering in accordance with all requirements of Good 
Manufacturing Practice (GMP) will be used, ensuring that each dose of study drug can be 
traced back to the respective bulk batch of the ingredients. Lists linking all numbering levels 
will be maintained by the sponsor’s clinical supplies quality assurance (QA) group. 
A complete record of batch numbers and expiry dates of all study treatment as well as the 
labels will be maintained in the sponsor’s study file.

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Table 7–1
Identity of test drug / finerenone and matching placebo
Sponsor’s substance code
BAY 94-8862
Generic name / brand name
Finerenone
Sponsor’s material
name and number
finerenone TABL 10 MG 450 COAT
finerenone TABL 20 MG 850 COAT
finerenone PLAC TABL 002 COAT
Formulation
Film-coated tablet
Tablet strength
10 mg and 20 mg or placebo
Composition
Active ingredient:
finerenone micronized
Other ingredients:
Cellulose microcrystalline, croscarmellose sodium, hypromellose 
5 cP, lactose monohydrate, magnesium stearate, sodium laurilsulfate, 
talc, titanium dioxide, ferric oxide
Placebo
Cellulose microcrystalline, hypromellose 5 cP, lactose monohydrate, 
magnesium stearate, talc, titanium dioxide, ferric oxide
Type of primary packaging
Plastic bottle high-density polyethylene white opaque closed with screw 
cap polypropylene (PP) / PP white with sealing insert
Marketing Authorization Holder
Not applicable
7.3
Treatment assignment - amended
This section was changed in Amendment 3, see Section 15.1.2.8.
Eligible subjects will be randomized within ≤2 weeks after the Screening Visit. The
randomization will be stratified by region (North America, Europe, Asia, Latin America and 
others), type of albuminuria at screening (high or very high albuminuria) and eGFR at 
screening (25 to <45, 45 to <60, ≥60 mL/min/1.73m²) and history of CVD (present, absent; 
see definition of CVD in Table 16–5). The eGFR will be calculated by the Central Laboratory 
applying the CKD-EPI formula (36).
The number of subjects with high albuminuria and eGFR ≥60 mL/min/1.73 m2 will be 
capped at approximately 10% of the total population with high albuminuria at screening. The 
number of subjects with high albuminuria and without a history of CVD will be capped at 
approximately 40% of the total population with high albuminuria at screening.
7.4
Dosage and administration - amended
This section was changed in Amendment 3, see Section 15.1.2.9.
As shown in Table 7–2, the starting dose of finerenone will depend on the eGFR value at the 
Screening Visit.
Thus, at randomization, subjects with an eGFR between 25 to < 60 mL/min/1.73m² at the 
Screening Visit (central laboratory results) will be assigned to the lower dose of finerenone 

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(10 mg) or placebo in addition to SoC, whilst subjects with an eGFR ≥60 mL/min/1.73m² will 
be assigned to the higher dose of finerenone (20 mg) or placebo in addition to SoC.
Table 7–2
Dosage of study drug for administration
eGFR value at the Screening Visit, 
based on central laboratory 
results:
25 to < 60 mL/min/1.73m²
≥60 mL/min/1.73m²
Subject randomized to group:
Finerenone
Placebo
Finerenone
Placebo
Receives
10 mg finerenone 
OD + SoC
Placebo OD
+ SoC
20 mg finerenone OD
+ SoC
Placebo OD
+ SoC
Study drug intake
One tablet of SD once daily,
preferably in the morning at approximately the same time each day.
Missed intake
If >8 hours before the next scheduled dose, the subject should take 
one tablet of SD as soon as possible.
If ≤8 hours of the next scheduled dose, the subject should wait and 
take the next tablet of SD at the usual time.
Up-titration of dose
Allowed from Visit 2 (Month 1) 
onwards provided that:
Potassium is ≤4.8 mmol/L a
eGFR decrease is less than 
30% below the value measured at 
the last scheduled visit a
Must be documented in eCRF
20 mg finerenone 
OD, maintain SoC
Sham-titrate, 
maintain SoC
Not applicable
Not applicable
Down-titration of dose
Only for safety reasons (for 
guidance, see Section 9.7.1)
Allowed any time during the study 
(e.g. between scheduled visits)
Must be documented in eCRF
An unscheduled safety visit is 
performed within an adequate  
timeframe proposed by the 
investigator

If at higher dose of SD, down-titrate to lower dose of SD, maintain 
SoC

If at lower dose of SD, interrupt SD, maintain SoC
Abbreviations:
eGFR = estimated glomerular filtration rate; SD = study drug; SoC = standard of care
a Potassium and eGFR according to local laboratory values
Intake of study drug
Subjects will be instructed to take one tablet of study drug, preferably in the morning, at 
approximately the same time each day. The study drug can be taken with a glass of water, 
with or without food.

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Missed intake of study drug
If the subject misses his/her scheduled daily intake of study drug, he/she should consider the 
following 2 options before continuing study drug intake:
(1) If intake of the missed tablet is discovered >8 hours before the next scheduled dose, the 
subject should take the study drug as soon as possible
(2) If the missed intake is discovered within 8 hours of the next scheduled dose, 
the subject should wait and take the next tablet at the usual time.
Up- and down-titration of study drug
The investigator is encouraged to up-titrate the dose of study drug at any time once the patient 
has been on a stable dose for 4 weeks (± 7 days) (e.g. from Visit 2 onwards for patient starting 
study drug on the lower dose) either at a regular visit or an Up-titration Visit. Up-titration can 
be performed   provided:

the potassium concentration (local laboratory value) is ≤4.8 mmol/L,
AND

eGFR decrease (local laboratory value) is less than 30% below the value measured at 
the last regular visit. 
Subjects who started with or were up-titrated to the target dose (20 mg OD) of the study drug 
but who do not tolerate this dose may be down-titrated at any point during the study, 
including between-scheduled visits if required for safety reasons. These subjects may be 
up-titrated again based on the rules provided above. If the subject is already at the lower dose, 
the study drug can be interrupted at the investigator’s discretion (refer to Section 9.7.1 for 
guidance). If the study drug is interrupted for more than 7 days, the study drug should be re-
started at the lower dose (10 mg OD).
Subsequent to an up-titration or re-start of study drug after interruption of study drug intake
for more than 7 days, the investigator should perform an Up-titration Visit 4 weeks (±7 days) 
after titration or restart, in order to monitor potassium levels and renal function (see 
Table 9–1). If a regular study visit will be scheduled to take place 4 weeks (± 7 days) after up-
titration, the monitoring of potassium and renal function is assured and no Up-titration Visit 
has to be performed in addition. With down-titrations, the unscheduled safety visit may need a 
smaller time window and should be performed at the investigator’s discretion.
At any point during study drug treatment, if blood potassium is found to be elevated, 
study drug treatment should be adjusted according to guidance provided in Section 9.7.1.
Both up- and down-titrations will be at the investigator’s discretion and will depend on the 
general clinical condition of the individual subject. The investigator should attempt to reach 
the maximum (target) dose of study drug as long as safety is not compromised.
All titrations, including the reasons for down-titration or for not dispensing the 20 mg dose, 
must be documented in the eCRF.

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7.5
Blinding
Blinding measures
7.5.1
Finerenone IR tablets (10 mg and 20 mg) and placebo tablets will be identical in appearance 
(size, shape, color). The packaging and labeling will be designed to maintain the blinding of 
the investigator’s team and the subjects. The study data will remain blinded until database 
lock and authorization of data release according to standard operating procedures.
Appropriate measures will be taken to maintain blinding while bioanalysis is ongoing.
Unblinding - amended
7.5.2
This section was changed in Amendment 3, see Section 15.1.2.10.
In compliance with applicable regulations, in the event of a SUSAR (see Section 9.6.1.4) 
related to the blinded treatment, the subject’s treatment code will usually be unblinded before 
reporting to the health authorities and ethic committees.
In order to maintain the integrity of the study, SUSARs will be waived from unblinding and 
expedited safety reporting if it represents one of the pre-specified disease-related efficacy 
endpoints (see also Section 9.6.1.4).
Emergency unblinding by the investigator
7.5.3
In the event of an emergency or any finding that requires unblinding, the investigator may 
break the blind for an individual subject via the IxRS according to the unblinding procedure 
outlined in the Investigator’s Guide. This system allows the investigator, or other responsible 
person, to identify the study drug if there is an emergency, without jeopardizing the 
double-blind integrity of the remainder of the study.
The code can be broken by the investigator, or other responsible person, when knowledge of 
the subject’s treatment is required for the clinical management of the subject. If it becomes 
necessary to know the individual treatment during the study and thus to break the code for 
that subject, the date and reason for unblinding are to be recorded on the relevant eCRF page. 
The investigator is required to promptly document and explain to the sponsor any premature 
unblinding (e.g. unblinding due to a serious adverse event [SAE]) of the study drug), 
and study drug must be discontinued permanently.
7.6
Drug logistics and accountability
All study drugs will be stored at the investigational site in accordance with GCP and GMP 
requirements and the instructions given by the clinical supplies department of the sponsor (or 
its affiliate/CRO), and will be inaccessible to unauthorized personnel. Special storage 
conditions and a complete record of batch numbers and expiry dates can be found in the 
sponsor’s study file; the site-relevant elements of this information will be available in the 
investigator site file. On the day of receipt, the responsible site personnel will confirm receipt of 
study drug via IxRS. The personnel will use the study drug only within the framework of this 

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clinical study and in accordance with this protocol. Receipt, distribution, return and destruction 
(if any) of the study drug must be properly documented according to the sponsor’s agreed and 
specified procedures.
Written instructions on study drug destruction will be made available to affected parties as 
applicable.
7.7
Treatment compliance
To monitor compliance, the investigator will be required to complete a drug dispensing log 
for each subject. The date of dispensing the study drug to the subject will be documented.
Study drug will be dispensed at each scheduled visit starting from Visit 1 (Day 1), as applicable.
Subjects will be instructed to return all of the study drug packaging including unused study 
drug and empty packaging.  Accountability must be performed at each visit (if applicable). 
Any discrepancies between actual and expected amount of returned study medication must be 
discussed with the subject at the time of the visit, and any explanation must be documented in 
the source records.
8.
Non-study therapy
8.1
Prior and concomitant therapy
General considerations for prior and concomitant therapy
8.1.1
Figure 8–1 depicts the conditions of prior therapy on ACEIs and ARBs during the time 
leading up to the Screening Visit.  

For at least 4 weeks prior to the Run-in Visit, all subjects must be treated with  
either an ACEI or ARB, or both

Starting with the Run-in Visit, subjects should be treated with only an ACEI or ARB

For at least 4 weeks prior to the Screening Visit, subjects should be treated with the 
maximum tolerated labeled dose (but not below the minimal labeled dose) of 
only an ACEI or an ARB (not both), preferably without any adjustments to dose or 
choice of agent or to any other antihypertensive or antiglycemic treatment.

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Figure 8–1
Background therapy with RAS blockade
‡
If applicable
*
During the maintenance phase, there should preferably be no adjustments to dose of ACEI or ARB or to any other 
antihypertensive or antiglycemic treatment
The maximum tolerated labeled dose for ACEIs or ARBs should be the highest dose within
the ranges shown in Table 8–1 or according to local labels, as applicable, which the subject 
can safely tolerate. This dose should not be below the minimum labeled dose in order to 
maximize therapeutic benefit of background SoC.
Table 8–1
Dose ranges of ACEIs and ARBs for adults
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Generic name
Dose Range (mg/day)*
Generic name
Dose Range (mg/day)*
Benazepril
20 – 40
Candesartan
16 – 32
Captopril
50 – 450
Eprosartan
400 – 800
Cilazapril
1 – 5
Irbesartan
150 – 300
Enalapril
10 – 40
Losartan
50 – 100
Fosinopril
20 – 80
Olmesartan
20 – 40
Lisinopril
20 – 40
Telmisartan
40 – 80
Moexipril
7.5 – 30
Valsartan
80 – 320
Perindopril
4 – 16
Quinapril
20 – 80
Ramipril
2.5 – 20
Trandolapril
2 – 4
Source: Adapted from Table 28 of reference (38)

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Variations to these recommended dose ranges may exist in local clinical guidelines or labels. 
If the maximum labeled dose cannot be reached, the reason(s) should be documented in the 
eCRF. Antihypertensive therapy for renal and CVD protection will be administered according 
to local guidelines (see also Section 8.1.2 on medical management).
Depending on blood pressure, serum creatinine or eGFR, subjects may need to have their study 
drug dose or the dose of another concomitant medication reduced or discontinued. The dosage 
of SoC therapies should not be reduced in order to solely facilitate maintenance of study drug.
Prior medication that was discontinued to comply with the eligibility criteria of the study 
should also be recorded in the eCRF.
All concomitant medication including therapy for T2DM and DKD until the PT Visit will be 
recorded in the eCRF.
The following therapies are NOT permitted:

Concomitant therapy with eplerenone, spironolactone, any renin inhibitor, or 
potassium-sparing diuretic which cannot be discontinued at least 4 weeks prior to the 
Screening Visit and during study drug treatment

Concomitant therapy with both an ACEI and an ARB during the Run-in and Screening
periods, and during study drug treatment

Concomitant therapy with potent cytochrome P450 isoenzyme 3A4 (CYP3A4) 
inhibitors or inducers must be stopped at least 7 days before randomization and
is not allowed to be started during study drug treatment
A list of the most common medication regarded as potent CYP3A4 inhibitors or inducers is 
provided in Section 16.1.
Caution: Increases in finerenone exposure in combination with the following moderate 
CYP3A4 inhibitors cannot be excluded: amiodarone, aprepitant, bicalutamide, 
chloramphenicol, imatinib, mifepristone, norfloxacine, tacrolimus, verapamil, 
lapatinib, dasatinib, and nilotinib. Caution should also be exercised with 
concomitant use of high-dose acetylsalicylic acid (>500 mg/day), non-steroidal 
anti-inflammatory agents or trimethoprim or trimethoprim / sulfamethoxazole.
Medical management
8.1.2
ACEIs and ARBs are considered as SoC therapy in patients with DKD and often prescribed to 
patients with DKD at early stages (8).
It is advisable to follow the recommendations of local guidelines for the management of 
CVD and CKD, the use of statins, anti-platelets and beta-blockers, and for glycemic control.

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Control of blood pressure - amended
8.1.3
This section was changed in Amendment 3, see Section 15.1.2.11.
According to international guidelines, the recommended target blood pressure for subjects 
with T2DM and albuminuria, who are at increased risk of CVD and CKD progression, is 
<130/80 mmHg (39-41). However, this value may vary for the individual subject depending 
on concomitant diseases and well-being.
If blood pressure is considered uncontrolled by the investigator during the study period, 
non-potassium-sparing diuretics may be added as first choice to the treatment regimen if this 
was not already done. Thereafter, the addition of antihypertensive medication can be 
performed according to local guideline recommendations.
All concomitant medication added to the treatment regimen during the course of the study 
must be recorded in the eCRF
Use of potassium supplements and lowering agents
8.1.4
If needed, potassium supplementation can be prescribed during the course of the study. 
Investigators are advised to monitor potassium carefully at each visit and to adapt the dose of 
any potassium supplementation in accordance with the potassium value measured at each visit 
or discontinue potassium supplementation once the potassium is within the normal range.
Potassium-lowering agents (e.g. sodium polystyrene sulfonate, calcium polystyrene sulfonate) 
are allowed to be started during treatment with study drug.
Any use of potassium supplementation and potassium-lowering agents must be documented 
in the eCRF.
8.2
Post-study therapy
The investigator will decide in consultation with the individual subject if additional treatment 
is required and choose from existing treatment options.
The investigator must provide follow-up medical care for all subjects who complete the study 
or who are prematurely withdrawn from the study, or must refer them for appropriate ongoing 
care as required.

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9.
Procedures and variables
9.1
Tabular schedule of evaluations - amended
This section was changed in Amendment 3, see Section 15.1.2.12 and Section 15.1.2.13.
Table 9–1 depicts the schedule of activities and evaluations for this study (17530).
An overview of the procedures for sub-studies of 17530 is provided in Table 9–2.
All randomized subjects will remain in the study until its termination, either:
(1) after positive adjudication of the targeted number of primary efficacy endpoint events, 
or
(2) at a recommendation of the DMC.
Thus, all subjects, including those who stopped taking study drug, should be asked to attend 
all the protocol-specified study visits in order to perform all assessments as stipulated in the 
visit schedule (Table 9–1).
If any subject refuses to return for the defined assessments or is unable to do so, every effort 
should be made to contact him/her or a knowledgeable informant by telephone to ask if any of 
the primary, secondary, or other endpoints have been reached at the scheduled visits for the 
remaining duration of the study (see Section 6.4.1.1 for details). Attempts to contact the 
subject should be documented in the subject’s records. If any subject refuses to be contacted 
by telephone (e.g. the subject withdrew consent to release further information), every effort 
should be made to obtain vital status (alive or dead) information through consultation of 
public databases, wherever allowed by local regulations.

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Table 9–1
Study 17530: schedule of activities and evaluations - amended
Visit 
Run-in
Screening
Visit
1 
(Baseline)
Visit 
2
Visit 
3
Visit
4, 6, 7, 9,
etc h
Visit
5, 8, 11, 
etc
Up-titration 
Visit j
PD
Visit
EOS
Visit k
PT
Visit m
Day / Month
4 to 16 
weeks pre-
screening
2 weeks
Day
1
Month
1
Month
4
(every 
4 months, 
i.e. 
Month 8, 16, 
20, 28, etc)
(every 
12 months, 
i.e. 
Month 12, 
24, 36, etc)
For up-titration/restart 
after interruption, 
and for safety check 
4 weeks ± 7 days after 
any up-titration 
(see also footnote j)
As soon as 
possible but 
within 7 days 
after SD is 
permanently 
discontinued
After
study 
termi-
nation
4 weeks 
+ 5 days 
after last 
SD intake 
Informed consent
X
In- and exclusion criteria
X
X
X
Demographic data
X
Smoking status
X
Alcohol consumption
X
Medical history
X
Prior medication
X
Concomitant medication
X
X
X
X
X
X
X
X
X
X
X
Randomization
X
Drug accountability
X
X
X
X
X
X
X
Study drug dispense
X
X
X
X
X
Study drug administration
X
X
KDQOL-36, EQ-5D-5L
X
X
X
X
Physical examination
X
X
X
X
X
Weight, height,
waist and hip circumference a
X
X
X
X
X
X
X
X
X
X
Vital signs b
X
X
X
X
X
X
X
X
X
X
12-lead ECG (local)
X
X
X
X
X
X
PK blood sample
X n
X o
Full central laboratory
X
X
X
X
X
X
X
X
Limited chemistry (central) 
X
X
Urinalysis (central) c
X
X
X
X
X
X
Safety laboratory (local) d
X
X
X
X
X
X
Endpoint assessment e
X
X
X
X
X
X
X
AE assessment f
X
X
X
X
X
X
X
X
X
X
X
Pregnancy test g
X
X

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Table 9–1
Study 17530: schedule of activities and evaluations - amended
NOTE: 
One month corresponds to 30 days
A time frame of ± 7 days is allowed for Visit 2 (Month 1), and for the Up-titration Visit(s).
A time frame of ± 12 days is allowed for all regular visits from Visit 3 (Month 4) onwards.
Abbreviations:
ECG = electrocardiogram; EOS = end of study; EQ-5D-5L = EuroQol Group 5 dimension, 5 level questionnaire; KDQOL = Kidney Disease Quality of Life; 
PD = premature discontinuation; PT = post-treatment; (S)AE = (serious) adverse event; SD = study drug
a
Height, waist and hip circumference to be assessed at Run-in Visit only.
b
After resting for at least 5 minutes, 3 measurements to be taken with at least 1-minute interval in a sitting position (all 3 readings within a maximum of 
20 minutes).
c
At Visit 1, first morning void urine samples to be preferably collected on three consecutive days at the subject’s home within 7 days before scheduled visit 
and before any intake of study drug. At the other visits the 3 consecutive samples can be collected ± 7 days from the visit date.
d
Blood samples (for potassium and creatinine) for measurement in the local laboratory may be obtained up to 72 hours before a scheduled visit.  Samples to 
be taken only if the subject is still taking study drug.
e
Categorical renal endpoints, ≥40% or ≥57% decrease in eGFR compared to baseline and an eGFR decrease to less than 15 mL/min/1.73 m2, have to be 
confirmed by at least one additional standardized serum creatinine measurement.  This confirmation should be done at least 4 weeks after the initial 
measurement as an unscheduled assessment.
f
AEs related to study procedures occurring after signing the informed consent as well as all other AEs starting after randomization will be documented on the 
respective eCRF pages.
g
Female subjects of childbearing potential must have a negative serum or urine pregnancy test at screening and yearly thereafter (to be performed at the local 
laboratory). If required by national / institutional regulations, a serum or urine pregnancy test in subjects of childbearing potential should be performed 
more often (e.g. at every visit, see Section 9.7.2).
h
Every 4 months until study termination, excluding the yearly visits (i.e. Visits 5, 8, 11, etc., at Months 12, 24, 36, etc.). 
j
The “Up-titration Visit” should be performed for up-titration (at any time after Visit 2), after restart of SD after an interruption for >7 days, and for safety check 
4 weeks ± 7 days after any up-titration.
k
After the study site is notified about study termination, an EOS Visit must be performed for all the subjects as soon as possible and within 4 weeks at the 
latest. 
m
For all the subjects still on treatment with study drug at the EOS Visit, the PT Visit has to be performed 4 weeks + 5 days after last intake of study drug and 
will be performed by a telephone contact (except for subjects participating in the iohexol sub-study).
n
A trough PK sample will be drawn before study drug is administered at the study center by study personnel. The exact time of study drug intake on the day 
before the visit and on the day of the visit and the exact sampling time will have to be recorded in the eCRF. If the trough sample was not taken at Visit 3 it 
should be obtained at Visit 4 (see Section 9.5).
o
Study drug will be taken as usual, ideally in the morning at home. One PK sample will be drawn during the visit. The exact time of study drug intake and the 
exact sampling times will have to be recorded in the eCRF.

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Table 9–2
Sub-studies of Study 17530: schedule of procedures – amended
Visit 
Run-in
Screening
Visit 
1 
(Baseline)
Visit 
2
Visit 
3
Visit
4, 6, 7, 9,
etc
Visit
5, 8, 11, etc
Up-titration visit
PD
visit
EOS
visit
PT
visit c
Day / Month
4 to 16 weeks 
pre-
screening
2 weeks
Day
1
Month
1
Month
4
(every 
4 months, 
i.e. 
Month 8, 16, 
20, 28, etc)
(every 
12 months, 
i.e. 
Month 12, 24, 
36, etc)
For up-titration/restart 
after interruption, 
and for safety check 
4 weeks ± 7 days after 
any up-titration
As soon as 
possible but 
within 7 days 
after SD is 
permanently 
discontinued
After
study 
termi-
nation
4 weeks 
+ 5 days 
after last 
SD intake 
Informed consent a
X
Echocardiography f
X
X
X e
X e
Sampling for biomarkers
X
X
X
X e
X e
Iohexol clearance b
X
X
X d
X d
X e
X e
X
NOTE: 
One month corresponds to 30 days.
A time frame of ± 7 days is allowed for Visit 2 (Month 1).
A time frame of ± 12 days is allowed all regular visits from Visit 3 (Month 4) onwards.
Abbreviations: EOS = end of study; PD = premature discontinuation PK = Pharmacokinetics; PT = post-treatment; SD = study drug
a
Separate informed consent for each sub-study is required. 
b
Sites in Italy only. 
c
For all the subjects still on treatment with study drug at the EOS Visit, the PT Visit has to be performed 4 weeks + 5 days after last intake of study drug. 
d
Every other visit (every 8 months), i.e. Visit 5, Visit 7, Visit 9, Visit 11, etc.
e
Assessment at the end of the study, either at the PD Visit or the EOS Visit.
f   Time window for the assessment at Visit 1 is -14/+7 days, at other visits ± 30 days. Each time an echocardiography is performed, one blood sample should be 
drawn to assess the echo biomarkers.

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9.2
Visit description - amended
This section was changed in Amendment 3, see Section 15.1.2.14.
One month in the study schedule corresponds to 30 days. Although study visits should occur 
as close as possible to the time points specified in the protocol, a time frame of ± 7 days is 
allowed for Visit 2 (Month 1), and for the Up-titration Visit(s). Starting from Visit 3 (Month 
4), a time frame of ± 12 days is allowed for all regular visits.
All procedures and assessments should preferably be conducted on the day of the visit; 
however, if this is not possible for logistical reasons, the following time windows are allowed:
Blood sampling, ECG and recording of vital signs:

Screening Visit and all visits starting from Visit 2: Visit date ± 7 days

Run-In, PD and EOS Visit: Visit date ± 3 days
Sub-studies / iohexol and biomarker samples:

all visits starting from Visit 3: Visit date ± 7 days

PD and EOS Visit: Visit date ± 3 days
Sub-study / echocardiography (note that each time an echocardiography is performed, one 
blood sample should be drawn to assess the echo biomarkers):

at Visit 1: Visit date -14 / +7 days

Other visits: Visit date ± 30 days
NOTE:
If applicable, a subject who is not eligible at the Run-in or Screening Visit may be 
re-screened at a later time (see Section 6.4.2.1) or switch over to Study 16244 (see 
Section 6.4.2.2) provided the pre-requisites are met.
Run-in Visit (4 to 16 weeks prior to the Screening Visit) - amended
9.2.1
This section was changed in Amendment 3, see Section 15.1.2.15.
The following procedures and assessments will be performed at the Run-in Visit:

Obtain signed informed consent (may be done earlier).
NOTE: any study-specific procedure can be performed only if written informed 
consent is available

Check inclusion and exclusion criteria (see Sections 6.1 and 6.2)

Collect demographic data, smoking status and alcohol consumption (see Section 9.3.1)

Record medical history (see Section 9.3.2)

Record use of prior and concomitant medication (see Section 8.1)

Perform physical examination (see Section 9.7.3)

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
Record body weight, height, waist and hip circumference (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Perform 12-lead ECG (see Section 9.7.6)

Take samples (hematology, HbA1c, chemistry and urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1).
Note: If HbA1c cannot be analysed by the central laboratory due to technical reasons, 
subject can be considered suitable for randomization with one result only (Run-In or 
Screening).

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3)
Screening Visit (≤2 weeks prior to Visit 1) - amended
9.2.2
This section was changed in Amendment 3, see Section 15.1.2.16.
The following procedures and assessments will be performed at the Screening Visit:

Check inclusion and exclusion criteria (see Sections 6.1 and 6.2)

Record use of concomitant medication (see Section 8.1)

Perform physical examination (see Section 9.7.3)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Perform 12-lead ECG (see Section 9.7.6)

Take samples (hematology, HbA1c, chemistry, urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1)
Note: If HbA1c cannot be analysed by the central laboratory due to technical reasons, 
subject can be considered suitable for randomization with one result only (Run-In or 
Screening).

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3)

Perform pregnancy test (see Section 9.6.2).
Visit 1 (randomization; Day 1 and baseline) - amended
9.2.3
This section was changed in Amendment 3, see Section 15.1.2.17.
All measurements on Visit 1 are to be performed on the day of the visit before first study drug 
intake. The following procedures and assessments will be performed at Visit 1:

Instruct the subject on how to complete KDQOL-36 and EQ-5D-5L questionnaires; 
the subject completes the questionnaires (see Section 9.7.7).

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
Obtain informed consent for sub-studies (see Section 9.7.8.1)

Check inclusion and exclusion criteria (see Sections 6.1 and 6.2)

Record use of concomitant medication (see Section 8.1)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Perform 12-lead ECG (see Section 9.7.6)

Take samples (hematology, HbA1c, chemistry, urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1)

Take samples (potassium, creatinine) for local safety laboratory evaluations (see 
Section 9.7.2.2)

Optional: if the subject had signed informed consent for the sub-study, obtain 
respective samples for biomarkers (see Section 9.7.8.1.2) and/or iohexol clearance 
(see Section 9.7.8.1.3), perform echocardiography (see Section 9.7.8.1.1)
Note: Time window for the echocardiography at Visit 1 is -14/+7 days. On the day the 
echocardiography is performed, a blood sample should also be drawn to assess the 
echo biomarkers.

Randomization to finerenone or placebo once daily (see Section 7.1)

Dispense the study drug (see Section 7.2)

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3)

First administration of study drug.
Visit 2 (Month 1)
9.2.4
The following procedures and assessments will be performed at Visit 2:

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance 
(see Section 7.6)

Dispense the study drug (see Section 7.2)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Take samples (limited chemistry) central laboratory evaluations (see Section 9.7.2.1)

Take samples (potassium, creatinine) for local safety laboratory evaluations (see 
Section 9.7.2.2)

Assess if the subject has any endpoint event(s) (see Table 13–1 and Section 9.6.1.3.1) 

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
Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).
Visit 3 (Month 4) - amended
9.2.5
This section was changed in Amendment 3, see Section 15.1.2.18.
Ideally, the study personnel should contact the subject prior to Visit 3 to remind them not to 
take the study drug as usual in the morning at home. The following procedures and 
assessments will be performed at Visit 3:

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance (see 
Section 7.6)

Dispense the study drug (see Section 7.2)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Take samples (hematology, HbA1c, chemistry, urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1)

Take samples (potassium, creatinine) for local safety laboratory evaluations 
(see Section 9.7.2.2)

Obtain pre-dose sample for PK (see Section 9.5)

Administer study drug after PK sample has been obtained (see Section 9.5)

Optional: if the subject had signed informed consent for the sub-study, obtain 
respective samples for biomarkers (see Section 9.7.8.1.2) and/or iohexol clearance 
(see Section 9.7.8.1.3)

Assess if the subject has any endpoint event(s) (see Table 13–1 and Section 9.6.1.3.1) 

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).
Visit 4, 6, 7, 9, etc. (every 4 months; Month 8, 16, 20, 28, etc., excluding 
9.2.6
yearly visits) - amended
This section was changed in Amendment 3, see Section 15.1.2.19.
The following procedures and assessments will be performed at Visit 4, 6, 7, 9, etc.:

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance 
(see Section 7.6)

Dispense the study drug (see Section 7.2)

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
Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Take samples (hematology, HbA1c, chemistry) for central laboratory evaluations 
(see Section 9.7.2.1)

Take samples (potassium, creatinine) for local safety laboratory evaluations 
(see Section 9.7.2.2)

Visit 4 only: Obtain pre-dose sample for PK if no PK sample was taken at Visit 3 (see 
Section 9.5)

Optional: if the subject had signed informed consent for the sub-study, obtain samples 
for iohexol clearance (see Section 9.7.8.1.3).  
Note: Iohexol clearance should be performed every 8 months only (Visit 7, Visit 9, 
etc.)

Assess if the subject has any endpoint event(s) (see Table 13–1 and Section 9.6.1.3.1) 

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).
Visit 5, 8, 11, etc. (every 12 months; Month 12, 24, 36, etc.) - amended
9.2.7
This section was changed in Amendment 3, see Section15.1.2.20.
The following procedures and assessments will be performed at Visit 5, 8, 11, etc.:

Subject to complete KDQOL-36 and EQ-5D-5L questionnaires (see Section 9.7.7).

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance 
(see Section 7.6)

Dispense the study drug (see Section 7.2)

Perform physical examination (see Section 9.7.3)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Perform 12-lead ECG (see Section 9.7.6)

Take samples (hematology, HbA1c, chemistry, urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1)

Take samples (potassium, creatinine) for local safety laboratory evaluations
(see Section 9.7.2.2)

Obtain sample for PK (see Section 9.5)

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
Optional: if the subject had signed informed consent for the sub-study, obtain samples 
for biomarkers (see Section 9.7.8.1.2), perform echocardiography (see Section 9.7.8.1.1)

Optional: if the subject had signed informed consent for the sub-study, obtain samples 
for iohexol clearance (see Section 9.7.8.1.3).  
Note: Iohexol clearance should be performed every 8 months only  (Visit 5, Visit 11, 
etc.)

Assess if the subject has any endpoint event(s) (see Table 13–1 and Section 9.6.1.3.1) 

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3)

Perform pregnancy test (see Section 9.6.2).
Up-titration Visit (4 weeks ± 7 days after up-titration or restart of 
9.2.8
study drug, and for up-titration of study drug) - amended
This section was changed in Amendment 3, see Section 15.1.2.21.
The following procedures and assessments will be performed at the Up-titration Visit (see 
Section 7.4 for details).

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance, if 
applicable (see Section 7.6)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Take samples (limited chemistry) central laboratory evaluations (see Section 9.7.2.1)

Take samples (potassium, creatinine) for local safety laboratory evaluations 
(see Section 9.7.2.2)

Assess if the subject has any endpoint event(s) (see Table 13–1 and Section 9.6.1.3.1) 

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).

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Premature Discontinuation (PD) Visit (as soon as possible but within 7
9.2.9
days after study drug is permanently discontinued) - amended
The section title was changed in Amendment 3, see Section 15.1.2.22.
If the PD visit cannot be performed within the timeframe specified, no PD visit is required. 
The following procedures and assessments will be performed at the PD Visit:

The subject completes KDQOL-36 and EQ-5D-5L questionnaires (see Section 9.7.7)

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance (see 
Section 7.6)

Perform physical examination (see Section 9.7.3)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Perform 12-lead ECG (see Section 9.7.6)

Take samples (hematology, HbA1c, chemistry) for central laboratory evaluations (see 
Section 9.7.2.1)

Optional: if the subject had signed informed consent for the sub-study, obtain 
respective samples for biomarkers (see Section 9.7.8.1.2) and/or for iohexol clearance 
(see Section 9.7.8.1.3), perform echocardiography (see Section 9.7.8.1.1)

Assess if the subject has any endpoint event(s) (see Table 13–1 and Section 9.6.1.3.1) 

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).
End of study (EOS) visit - amended
9.2.10
This section was changed in Amendment 3, see Section 15.1.2.23.
The following procedures and assessments will be performed at the EOS Visit:

The subject completes KDQOL-36 and EQ-5D-5L questionnaires (see Section 9.7.7)

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance (see 
Section 7.6)

Perform physical examination (see Section 9.7.3)

Record body weight (see Section 9.7.4)

Record vital signs (see Section 9.7.5)

Perform 12-lead ECG (see Section 9.7.6)

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
Take samples (hematology, HbA1c, chemistry, urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1)

Optional: if the subject had signed informed consent for the sub-study, obtain 
respective samples for biomarkers (see Section 9.7.8.1.2) and/or for iohexol clearance 
(see Section 9.7.8.1.3), perform echocardiography (see Section 9.7.8.1.1)

Assess if the subject has any endpoint event(s) (see Table 13–1 and Section 9.6.1.3.1)
o
Any eGFR declines that meet endpoint criteria that are identified at the EOS 
Visit, or that cannot be confirmed by the time of the EOS Visit, should be 
confirmed 4 weeks after the initial decline

In exceptional circumstances only, if the subject is unable to attend this visit during 
the given timeframe, the subject (or primary physician / next of kin) should be 
contacted to obtain survival status. 

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).
Post-Treatment (PT) Visit - amended
9.2.11
This section was changed in Amendment 3, see Section 15.1.2.24.
For all subjects (except those who participate in the iohexol clearance study) who are still on 
treatment with study drug at the end of study visit, this will be performed by telephone 
contact within 4 weeks + 5 days after last study drug intake. The following will be performed 
at the PT Visit:

Record use of concomitant medication (see Section 8.1)

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).
For subjects who signed informed consent for the iohexol clearance sub-study, the PT Visit 
will be performed as an on-site visit with the following procedures and assessments:

Record use of concomitant medication (see Section 8.1)

Obtain samples for iohexol clearance (see Section 9.7.8.1.3)

Record adverse events (see Section 9.6.1), accounting for the rules of assessment and 
documentation (see Section 9.6.1.3).

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9.3
Population characteristics
Demographic
9.3.1
The following demographic data will be collected in the eCRF:

Year of birth and age at the Run-in Visit

Ethnic group

Race

Sex

Smoking habits and alcohol consumption.
Medical history - amended
9.3.2
This section was changed in Amendment 3, see Section 15.1.2.25.
Medical history findings (i.e. previous diagnoses, diseases or surgeries) meeting all criteria 
listed below will be collected as available to the investigator:

Pertaining to the study indication or CVD history 

Start before randomization

Considered relevant to the study (e.g. CV and metabolic diseases, periodontal disease)

Medical history related to concomitant medication.
Detailed instructions on the differentiation between (1) medical history and (2) adverse events 
can be found in Section 9.6.1.1.
9.4
Efficacy - amended
This section was changed in Amendment 3, see Section 15.1.2.26.
The parameters in Section 9.4.1 (primary), Section 9.4.2 (secondary) and Section 9.4.3
(exploratory) will be used to assess the efficacy of the study drug.
Efficacy endpoints will be evaluated by a Clinical Event Committee (CEC) (see Section 13.1.2).
Kidney failure is defined as either the occurrence of ESRD or an eGFR of less than 15 
mL/min/1.73 m², confirmed by a second measurement at the earliest 4 weeks after the initial 
measurement.  ESRD is defined as the initiation of chronic dialysis (haemo- or peritoneal-
dialysis) for at least 90 days or renal transplantation.  The eGFR threshold of 15 mL/min/1.73 
m² is consistent with the definition of kidney failure from KDIGO (Kidney Disease: 
Improving Global Outcomes)(3) and was chosen in order to include an objective component 
to the endpoint because the decision to initiate dialysis therapy or kidney transplantation may 
be affected by factors other than the eGFR. All other definitions of individual endpoints (e.g. 
CV death) will be provided in the Endpoint Manual.

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Primary efficacy variable
9.4.1
The primary efficacy variable will be the time to first occurrence of the composite endpoint of 
CV death or non-fatal CV event (i.e. myocardial infarction, stroke, or hospitalization for HF).
Secondary efficacy variables
9.4.2
Secondary efficacy variables will be as follows:

Time to first occurrence of the following composite endpoint:
onset of kidney failure, a sustained decrease of eGFR ≥ 40% from baseline over at 
least 4 weeks, or renal death

Time to all-cause hospitalization 

Time to all-cause mortality

Change in UACR from baseline to Month 4 

Time to first occurrence of the following composite endpoint:
onset of kidney failure, a sustained decrease in eGFR of ≥57% from baseline over 
at least 4 weeks or renal death.
Other exploratory efficacy variables
9.4.3
Other exploratory efficacy variables will be as follows:

Time to onset of ESRD

Time to onset of eGFR decrease of ≥40 % sustained over at least 4 weeks

Time to onset of eGFR decrease of ≥57% sustained over at least 4 weeks

Time to CV death

Time to first CV hospitalization

Time to first non-fatal CV event
(e.g. myocardial infarction, stroke, hospitalization for HF)

Number of subjects with new diagnosis of atrial fibrillation or atrial flutter

Number of subjects with new diagnosis of HF

Change in UACR from baseline

Change in eGFR from baseline

Regression from very high to high albuminuria and high albuminuria to albuminuria 
accompanied by a decrease in UACR of at least 30% from baseline

Number of subjects with a UACR decrease of at least 30% from baseline at any time 
post-baseline

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
Number of subjects with a UACR decrease of at least 50% from baseline at any time 
post-baseline

Change in QoL summary scores measured by the following health-related quality of 
life (HRQoL) questionnaires: Kidney Disease Quality of Life (KDQOL-36) and 
EuroQol Group 5-dimension, 5-level questionnaire (EQ-5D-5L), see Section 9.7.7
for details.
9.5
Pharmacokinetics / pharmacodynamics - amended
This section was changed in Amendment 3, see Section 15.1.2.27.
For the investigation of systemic exposure to finerenone and its relationship with treatment 
effects, the plasma concentrations of finerenone will be determined at different time points 
using a sparse sampling approach in all participating subjects.  Details about the collection, 
processing, storage and shipment of samples will be provided separately (Laboratory Manual).
The plasma concentration versus time data of Visit 3 (Month 4) and at subsequent yearly 
visits will be evaluated descriptively, separated by dose. Plots will be prepared of all 
individual plasma concentrations vs. actual relative study times (time of sample collection 
after time of study drug administration). 
The PK data will be evaluated using non-linear mixed effect modeling (NONMEM). In 
addition, attempts will be made to identify whether the PK of finerenone is influenced by 
covariates and to explore exposure-response relationships. This evaluation will be described 
in a separate analysis plan and will be reported separately.
At Visit 3 (Month 4), a trough sample for the determination of finerenone plasma 
concentrations will be drawn before intake of study drug (if the sample could not be obtained 
at Visit 3, it can be drawn at Visit 4). At this visit, study drug will be administered at the study 
center by study personnel and the exact time of study drug intake on the day before the visit 
and on the day of the visit and the exact sampling time will be recorded in the eCRF. Ideally, 
the study personnel should contact the subject prior to Visit 3 to remind them not to take the 
study drug as usual in the morning at home.
At each of the yearly visits, one blood sample for the determination of finerenone plasma 
concentrations will be drawn during the visit after intake of study drug at home. The subjects 
should be advised to take their drug as usual in the morning at home and recall the time of 
drug intake. The exact time of study drug intake and the exact sampling times will be 
recorded in the eCRF.
PK sampling is not necessary if the study treatment was temporarily interrupted or 
permanently discontinued at the time of the visit.
The PK bioanalysis will be performed under the responsibility of Bayer Bioanalytics 
Laboratory, Bayer AG, 
 42096 Wuppertal, Germany. Study 
responsible bioanalytical personnel will remain unblinded during the study.  
PPD

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9.6
Safety
Adverse events
9.6.1
9.6.1.1
Definitions - amended
This section was changed in Amendment 3, see Section 15.1.2.28.
Definition of adverse event (AE)
An AE is any untoward medical occurrence (i.e. any unfavorable and unintended sign 
[including abnormal laboratory findings], symptom or disease) in a patient or clinical 
investigation subject. Therefore, an AE may or may not be temporally or causally 
associated with the use of a medicinal (investigational) product.
All diagnoses, symptom(s), sign(s) or finding(s) with a start date from randomization 
onwards must be recorded as (S)AEs, except those related to study procedure. The latter have 
to be recorded as (S)AEs after informed consent has been obtained (see also end of this 
section for definition of SAE).
A surgical procedure that was planned prior to randomization by any physician treating the 
subject should not be recorded as an AE (however, the condition for which the surgery is 
required may be an AE).
In the following differentiation between medical history and AEs, the term ‘condition’ may 
include abnormal physical examination findings, symptoms, diseases, laboratory or ECG 
findings:

Conditions that were present before randomization and for which no symptoms or 
treatment are present until randomization are recorded as medical history (e.g. 
seasonal allergy without acute complaints)

Conditions that started before randomization and for which symptoms or treatment are 
present after randomization, at unchanged intensity, are recorded as medical history (e.g. 
allergic pollinosis)

Conditions that started or deteriorated after randomization will be documented as 
(S)AEs

Conditions assessed as related to study procedure (such as invasive procedures and 
adjustment of SoC therapy [see Section 8.1.1 for guidance]) that start or deteriorate 
after signed informed consent must be documented as (S)AEs.

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Definition of serious adverse event (SAE)
An SAE is classified as any untoward medical occurrence that, at any dose, meets any of the 
following criteria (a – f):
a.
Results in death
b.
Is life-threatening
The term ‘life-threatening’ in the definition refers to an event in which the subject was 
at risk of death at the time of the event, it does not refer to an event which 
hypothetically might have caused death if it were more severe.
c.
Requires inpatient hospitalization or prolongation of existing hospitalization
A hospitalization or prolongation of hospitalization will not be regarded as an SAE if 
at least one of the following exceptions is met:

The admission results in a hospital stay of less than 12 hours

The admission is pre-planned
(e.g. elective or scheduled surgery arranged prior to the first dose of study drug; 
admission is part of the study procedures as described in Section 9.2)

The admission is not associated with an AE
(e.g. social hospitalization for purposes of respite care).
However, it should be noted that invasive treatment during any hospitalization may 
fulfill the criterion of ‘medically important’ and as such may be reportable as an SAE 
dependent on clinical judgment. In addition, where local regulatory authorities 
specifically require a more stringent definition, the local regulation takes precedence.
d.
Results in persistent or significant disability / incapacity
Disability means a substantial disruption of a person’s ability to conduct normal life’s 
functions.
e.
Is a congenital anomaly / birth defect
f.
Is another serious or important medical event as judged by the investigator.
9.6.1.2
Classifications for adverse event assessment
All AEs will be assessed and documented by the investigator according to the categories 
detailed below.
9.6.1.2.1
Seriousness
For each AE, the seriousness must be determined according to the criteria given in 
Section 9.6.1.1.

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9.6.1.2.2
Intensity
The intensity of an AE is classified according to the following categories:
Mild: usually transient in nature and generally not interfering with normal activities
Moderate: sufficiently discomforting to interfere with normal activities
Severe: prevents normal activities.
9.6.1.2.3
Causal relationship 
The assessment of the causal relationship between an AE and the administration of treatment 
is a decision to be made by the investigator, who is a qualified physician, based on all 
information available at the time of the completion of the eCRF.
The assessment is based on the question whether there was a ‘reasonable causal relationship’ 
to the study treatment in question.
Possible answers are ‘yes’ or ‘no’.
An assessment of ‘no’ would include:
1.
The existence of a highly likely alternative explanation, e.g. mechanical bleeding at 
surgical site.
or
2.
Non-plausibility, e.g. the subject is struck by an automobile when there is no 
indication that the drug caused disorientation that may have caused the event; cancer 
developing a few days after the first drug administration.
An assessment of ‘yes’ indicates that that the AE is reasonably associated with the use of the 
study treatment.
Important factors to be considered in assessing the relationship of the AE to study treatment 
include the following:
–
The temporal sequence from drug administration:
The event should occur after the drug is given. The length of time from drug exposure 
to event should be evaluated in the clinical context of the event.
–
Recovery on drug discontinuation (de-challenge), recurrence on drug re-introduction 
(re-challenge):
Subject’s response after de-challenge or re-challenge should be considered in view of 
the usual clinical course of the event in question.
–
Underlying, concomitant, intercurrent diseases:
Each event should be evaluated in the context of the natural history and course of the 
disease being treated and any other disease the subject may have.
–
Concomitant medication or treatment:
The other drugs the subject is taking or the treatment the subject receives should be 
examined to determine whether any of them might have caused the event in question.

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–
The pharmacology and pharmacokinetics of the study treatment:
The pharmacokinetic properties (absorption, distribution, metabolism and excretion) 
of the study treatment, coupled with the individual subject’s pharmacodynamics 
should be considered.
–
The assessment is not possible.
Causal relationship to protocol-required procedure(s)
The assessment of a possible causal relationship between the AE and protocol-required 
procedure(s) is based on the question whether there was a ‘reasonable causal relationship’ to 
protocol-required procedure(s). 
Possible answers are ‘yes’ or ‘no’.
9.6.1.2.4
Action taken with study treatment 
Any action on study treatment to resolve the AE is to be documented using the categories 
listed below as follows:
Drug withdrawn
Drug interrupted
Dose reduced
Dose not changed
Dose increased
Not applicable
Unknown.
9.6.1.2.5
Other specific treatment(s) of adverse events
Specific treatment of AE(s), if given, is to be documented follows:
None
Remedial drug therapy
Other.

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9.6.1.2.6
Outcome
The outcome of the AE is to be documented as follows: 
Recovered/resolved
Recovering/resolving
Recovered/resolved with sequelae
Not recovered/not resolved
Fatal
Unknown.
9.6.1.3
Assessments and documentation of adverse events (AEs) - amended
This section was changed in Amendment 3, see Section 15.1.2.29.
Attention is to be paid to the time of occurrence of AEs at all stages of the examination. Thus, 
the subject should be closely observed by the investigator.
AEs observed, mentioned upon open questioning by a member of the investigator’s team or 
spontaneously reported by the patient will be documented. The observation period for AEs 
will start with randomization and will end with the last visit of follow-up except for AEs 
related to study procedures; the observation period for the latter AEs will start with signed 
informed consent and will end with the last visit of follow-up. In the event of ongoing 
study-related AEs and medically relevant AEs at the end of the study, the investigator is urged
to monitor the subject and document the outcome on the subject’s source document. After the 
end of the follow-up phase, there is no requirement to actively collect AEs including deaths. 
The type of information that should be assessed and recorded by the investigator for each AE 
is listed in Section 9.6.1.2.
See also Section 9.6.1.1 above for the differentiation between medical history and AEs.
The investigator is responsible for the grading of each category mentioned. An assessment of 
the seriousness of the event will be made by the investigator.  SAEs will be recorded on the 
AE page of the eCRF.
Emerging AEs will be allocated to the period in which they have started, e.g. a symptom 
starting in the treatment period and continuing in the follow-up period without deterioration 
will only be documented for that treatment period.
When assigning its cause, ‘death’ should not be recorded as an AE on the AE page. Instead, 
‘death’ is the outcome of underlying AE(s). 
For all serious adverse events (SAEs), the sponsor has to carry out a separate assessment for 
expectedness, seriousness and causal relationship to study drug.

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9.6.1.3.1
Event versus outcome
The efficacy and pre-defined disease-related outcome events specified in Figure 9–1 will 
not be documented as (S)AEs.  Instead, these events will be documented only on the 
Outcome Event pages of the eCRF. In addition, they will not be reported as SAEs and will 
neither be unblinded, nor reported to regulatory authorities, IECs, or investigators (see also 
Section 9.6.1.4 for details). 
However, they will be collected in the eCRF, monitored by the DMC during the study and 
analyzed in the clinical report after study termination. If unexpected safety issues are 
identified, specific amendments will be implemented.
Figure 9–1
Medical finding during the study: event versus outcome

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9.6.1.4
Reporting of serious adverse events (SAEs) - amended
This section was changed in Amendment 3, see Section 15.1.2.30.
The definition of SAEs is provided in Section 9.6.1.1. Each SAE must be followed up until 
resolution or stabilization by submission of updated reports to the designated recipient.
The pre-defined disease-related efficacy events (see Table 13–1) will not be subject to AE 
documentation and expedited reporting as SAE because they are not unexpected in this study 
population. Thus, they will not be recorded as SAEs on the AE page and will not be sent to 
Sponsor’s Pharmacovigilance department.  Instead, these events will be recorded on the eCRF 
as outcome events. Consequently, they will neither be unblinded, nor reported to regulatory 
authorities, IECs or investigators. However, they will be collected in the eCRF, evaluated by 
the CEC, monitored by the independent DMC during the study and analyzed in the clinical 
study report after termination of the study. The independent DMC will periodically review 
and assess all safety data for imbalances in safety outcomes. It is believed that in this way, 
patient safety can continue to be monitored throughout the duration of the trial, without 
affecting the integrity of the study.  Should unexpected safety issues be identified, specific 
amendments will be implemented.
All other SAEs that fulfill the seriousness criteria provided in Section 9.6.1.1 must be 
collected on the AE page of the eCRF and reported as SAEs to the Sponsor’s 
Pharmacovigilance department. All SAEs that fulfill SUSAR criteria as defined by the 
ICH E2A Guideline will be reported to the concerned authorities by expedited means 
(see details below).
The investigator is responsible for continuing to follow-up on all SAE reports (whether or not 
the event is related to study drug) until resolution of the event, or until the event is considered 
chronic and/or stable by the investigator and/or other physician who is responsible for the 
subject’s medical care. Follow-up SAE reports will be reported according to the same 
timelines as initial reports, as soon as new significant information becomes available.
Investigator’s notification of the sponsor
All investigators will be thoroughly instructed and trained on all relevant aspects of the 
investigator’s reporting obligations for SAEs. This information, including all relevant contact 
details, will be summarized in the investigator site file and updated as needed.
The investigator must report immediately (within 24 hours of the investigator’s awareness) 
all SAEs that are not exempted from SAE reporting occurring during the observation period 
defined in Section 9.6.1.3 to the recipient detailed in the instructions for SAE reporting 
included in the Investigator File.
Each SAE must be followed up until resolution or stabilization by submission of updated 
reports to the designated recipient.
SAEs occurring after the protocol-defined observation period will be processed by the 
sponsor according to all applicable regulations.

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The efficacy and pre-defined disease-related outcome events as described in Section 9.6.1.3.1
will not be subject to AE documentation. Thus, they will neither be unblinded, nor reported to 
regulatory authorities, IECs, or investigators in the event of fulfilling criteria for a SUSAR.
Notification of the IECs / IRBs
Notification of the IECs / IRBs about all relevant events (e.g. SAEs, suspected, unexpected, 
serious adverse reactions [SUSARs]) will be performed by the sponsor and/or by the 
investigator according to all applicable regulations.
In compliance with applicable regulations, in the event of a SUSAR, the subject’s treatment 
code will usually be unblinded before reporting to the competent authorities, IECs/IRBs. For 
reporting to investigators the treatment blind will be kept.
Notification of the authorities
The processing and reporting of all relevant events (e.g. SAEs, SUSARs) to the authorities 
will be done by the sponsor according to all applicable regulations.
Sponsor’s notification of the investigational site
The sponsor will inform all investigational sites about reported relevant events (e.g. SUSARs) 
according to all applicable regulations.
9.6.1.5
Expected adverse events
For this study, the applicable reference document is the most current version of the IB for 
finerenone.
Overview listings of frequent events that have occurred so far in the clinical development are 
shown in the current IB. If relevant new safety information is identified, the information will 
be integrated into an update of the IB and distributed to all participating sites.
The expectedness of AEs will be determined by the sponsor according to the applicable 
reference document and according to all local regulations.
Pregnancies
9.6.2
Female subjects of childbearing potential must have a negative serum or urine pregnancy test 
at screening and at yearly-intervals during study participation. If required by 
national/institutional regulations, a serological or urine pregnancy test in subjects of 
childbearing potential should be performed more often (e.g. at every visit). 
The investigator must report to the sponsor any pregnancy occurring in a female study subject 
during her participation in this study. The outcome of the pregnancy should be followed up 
carefully, and any outcome of the mother and the child at delivery should be reported.
The child’s health should be followed up until birth.

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For a pregnancy in the partner of a male study subject, all efforts should be made to obtain 
similar information on course and outcome of the pregnancy and the health of the child, 
subject to the partner’s consent.
For all reports, the forms provided are to be used. The investigator should submit them within 
the same timelines as an SAE, i.e. within 24 hours of his/her awareness.
9.7
Other procedures and variables
Monitoring of blood potassium - amended
9.7.1
This section was changed in Amendment 3, see Section 15.1.2.31.
Hyperkalemia is a frequent event in subjects with DKD progressing to ESRD and one of the 
main risks identified from previous studies with MRAs including finerenone. Potassium will 
be monitored closely during this study, with assessments of potassium concentration 
scheduled at all visits (see Table 9–1 for schedule).
During treatment with study drug, all assessments of potassium, including re-tests, will be 
performed at both local and central laboratories. Due to sample handling and extended 
transportation time to the central laboratory, falsely elevated serum potassium values in 
centrally (but not locally) analyzed samples have been observed in previous studies with 
finerenone. Since the value of potassium in the local sample is usually not affected by this 
and results from the local laboratory are available earlier, local samples will be taken not only 
for safety purposes but also for dose adjustments.
Re-checking of potassium values must be done at the latest within 72 hours of the investigator 
being aware of results that need confirmation. The investigator can perform a re-test at any 
time if they consider it necessary to confirm the potassium concentration of the local or the 
central sample.
Adjustment of dose after start of study drug intake based on blood potassium levels is 
provided in Table 9–3. 
Table 9–3
Blood potassium: guidance for dose adjustment at Visit 2 and subsequent 
visits
Blood potassium (mmol/L)
Action
First sample:
≤4.8
If on lower dose of study drug, up-titrate to higher dose.
If on higher dose of study drug, continue on the same dose.
4.9 to 5.5
Continue on the same dose.
>5.5
Withhold study drug and re-check potassium within 72 hours.
Second and subsequent samples:
≤5.0
Re-start study drug at lower dose.
>5.0
Continue to withhold study drug; continue to monitor potassium and restart 
study drug at the lower dose only if potassium is ≤5.0
NOTE: lower dose = 10 mg once daily; higher dose = 20 mg once daily.

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The following aspects have also to be taken into consideration:

Blood potassium should be measured 4 weeks (± 7 days) after re-starting treatment or 
dose adjustment, especially after up-titration

If central laboratory results for blood potassium differ from local laboratory results to 
such an extent that the investigator is uncomfortable with the dose adjustment guidance 
shown in Table 9–3, blood sampling may be repeated at the investigator’s discretion

If the subject is already on the lower dose of study drug but hyperkalemia recurs soon 
after a previous event of hyperkalemia with interruption of study drug, and there is 
no explanation for the recurring hyperkalemia event other than intake of study drug, 
permanent discontinuation of study drug is recommended

If blood potassium is > 6.5 mmol/L, an ECG should be obtained

Subjects will maintain their normal diet throughout the study and will not be given any 
specific advice on dietary potassium restrictions.
Laboratory assessments
9.7.2
9.7.2.1
Central laboratory
The name and the address for the central laboratory service provider can be found in the 
documentation supplied by the vendor. Only centrally analyzed blood samples will be 
considered for statistical analysis, unless otherwise specified. Details of the collections, 
shipment of samples and reporting of results by the central laboratory will be provided to the 
investigators in the Laboratory Manual.
Laboratory evaluations (hematology, HbA1c, clinical chemistry and urinalysis parameters) 
are shown in Table 9–4. Hematology, HbA1c and (full) clinical chemistry are considered as 
‘Full central laboratory’ assessments.
Laboratory evaluations will be performed according to the visit schedule (see Table 9–1). 

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Table 9–4
Central laboratory parameters
Parameter
Component
Hematology
White blood cell count (WBC), red blood cell count (RBC), hemoglobin, 
hematocrit, mean corpuscular volume (MCV), 
mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), platelets
Glycated hemoglobin 
(HbA1c)
HbA1c only
Clinical chemistry
(full)
Aspartate aminotransferase (AST), alanine aminotransferase (ALT), 
alkaline phosphatase (AP), gamma glutamyl transpeptidase (GGT), 
lactate dehydrogenase (LDH), creatine kinase (CK),
cholesterol (high density lipoprotein [HDL], low density lipoprotein [LDL], total),
triglycerides, creatinine, eGFR (CKD-EPI), blood urea nitrogen, uric acid, 
bilirubin, sodium, serum potassium, magnesium, total protein, albumin, 
high-sensitivity C-reactive protein (hs-CRP)
Clinical chemistry
(limited)
Serum creatinine, eGFR (CKD-EPI), sodium, serum potassium
Urinalysis
Urine albumin-to-creatinine ratio (UACR) will be measured in the first morning 
void urine samples collected at the subject’s home on 3 consecutive days
9.7.2.2
Local laboratory - amended
This section was changed in Amendment 3, see Section 15.1.2.32.
In addition to samples for the central laboratory, other blood safety samples will be taken 
from Visit 1 (Day 1; baseline) onwards (see Table 9–1) for analysis at the local laboratory. 
These samples may be obtained up to 72 hours before a scheduled visit.
The following clinical chemistry parameters must be measured for as long as subject is not 
prematurely discontinued from the study drug:

Blood potassium

Blood creatinine (eGFR will be calculated automatically in the eCRF using the 
CKD-EPI formula (36)).
Up-titration of the study drug will be based on local potassium and eGFR values and must be 
documented in the eCRF. Down-titration of the study drug will occur for safety reasons only 
(for guidance, see Section 9.7.1 and Table 7–2).
Potassium values should be recorded using a single decimal point (e.g. 4.5 mmol/L or mEq/L).
In the event of hyperkalemia, please see Section 9.7.1 for guidance on treatment.
In women of childbearing potential, a pregnancy test will be performed locally, at the 
Screening Visit and following randomization at yearly visits as long as the subject is not 
permanently discontinued from the study drug (since more than 7 days). However, pregnancy 
tests in subjects of childbearing potential should be performed more frequently (e.g. at every 
visit) if this is required by national / institutional regulations. Both serological and urine tests are 
acceptable.

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Physical examination
9.7.3
Abnormal physical examination findings are recorded either as medical history or as an AE 
(see Section 9.6.1.1).
A complete physical examination will be performed at the Run-In and Screening Visits, at the 
yearly visits and again at the PD and EOS Visits (see Table 9–1). 
Weight, height, hip and waist circumference
9.7.4
Body weight (to the nearest 0.1 kg in indoor clothing without shoes) will be measured at 
all scheduled visits except the PT Visit (see Table 9–1).  Height as well as hip and waist 
circumference in centimeters will be only measured at the Run-in Visit.
Measurement of vital signs
9.7.5
Vital signs will be assessed at all scheduled visits except the PT Visit (see Table 9–1). This 
will include blood pressure (BP) and pulse measurements.
BP will be measured by using a standard sphygmomanometer with an appropriate size cuff in 
the sitting position after 5 minutes of rest.
There must be 3 consecutive BP readings with at least a 1-minute interval between each reading
(all 3 readings should be obtained within a maximum of 20 minutes).
The same arm and the appropriate size cuff should be used for measurements at each visit. 
Electrocardiogram (ECG) - amended
9.7.6
This section was changed in Amendment 3, see Section 15.1.2.33.
A standard 12-lead ECG will be performed locally at the Run-In Visit, Screening Visit, at 
Visit 1 (Day 1; baseline), at the yearly visits, and again at the PD and EOS Visits (see Table 
9–1). If there is any clinical indication, unscheduled 12-lead ECGs can be performed at any 
point during the study.
In addition, an ECG should be obtained if potassium >6.5 mmol/L.
The interpretation of the tracing must be made locally by a qualified physician.
The date of the recording must be documented on the ECG section of the eCRF. Each ECG 
tracing should be labeled with the study number, subject number, and date and kept in the 
source documents at the study site.
Clinically significant abnormalities should be reported as AEs or outcome event as appropriate
(e.g. new onset atrial fibrillation) when not already reported in the medical history or in one of 
the previous recordings and in the event of worsening of previous findings.
Health-related quality of life (HRQoL) questionnaires
9.7.7
HRQoL questionnaires will be completed by the subject at Visit 1 (Day 1; baseline), the 
yearly visits and at the PD and EOS Visits (see Table 9–1). The following HRQoL 

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questionnaires will be used: ▪Kidney Disease Quality of Life (KDQOL-36) and ▪EuroQol 
Group 5-dimension, 5-level questionnaire (EQ-5D-5L). A general description of these 
questionnaires is provided in Section 16.3.
The subject will be instructed to fill in the questionnaires himself / herself before any other 
procedure of each visit. Subsequently, a member of the site investigator’s team will enter the 
responses into the eCRF.
Planned optional sub-studies
9.7.8
9.7.8.1
Sub-studies
The results of the sub-studies for Study 17530 will not be presented in its main clinical study 
report (CSR) but will be provided as separate reports.
9.7.8.1.1
Echocardiography sub-study - amended
This section was changed in Amendment 3, see Section 15.1.2.34.
At selected centers, approximately 500 subjects per study consenting to participate in 
Studies 17530 and 16244 will be invited to take part in an echocardiography sub-study. 
Subjects will be asked to sign a separate informed consent to participate in this sub-study. 
Diabetes mellitus, hypertension and dyslipidemia are CV risk factors which contribute to the 
CVD continuum and potentially results in a sequence of CV events. The development of HF in 
subjects with DKD is the most common CV complication and imposes significant morbidity 
and mortality (30, 42). Patients with symptomatic HFrEF are excluded from the Phase III 
program of finerenone in DKD. However, before becoming symptomatic, sub-clinical cardiac 
dysfunction and abnormal leftventricular structure including leftventricular hypertrophy can 
be demonstrated in the majority of subjects with moderate CKD. Imaging plays a central role 
in the diagnosis of structural heart disease. Of the various imaging modalities available, for 
reasons of accuracy, availability, safety and cost, echocardiography is the method of choice in 
subjects with suspected or the beginnings of structural heart disease.
In all participating sites, echocardiography will be performed according to a study-specific 
protocol at Visit 1 (Day 1; baseline), at yearly visits and at the end of the study (either at the 
PD Visit or the EOS Visit). If a baseline assessment is not available or analysable, the subject 
will not continue to undergo echocardiography assessments due to the inability to perform a 
comparison against baseline. 
Echocardiography examinations, data collection and procedures for central blinded adjudication 
in the echo core laboratory are given in the Echocardiography Manual. In addition, each time an 
echocardiography is performed, one blood sample should be drawn to assess the following 
biomarkers shown in Table 9–5.

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Table 9–5
Echocardiography sub-study: biomarkers for evaluation
Biomarker
Mechanism
Rationale for assessing this biomarker
NT-proBNP
myocardial 
pressure-volume 
overload
NT-proBNP is typically increased in patients with asymptomatic or 
symptomatic left ventricular dysfunction and is associated with coronary 
artery disease and myocardial ischemia.
Galectin-3
(Cardiac) fibroblast / 
cardiomyocyte stress
Gal-3 is barely detectable in cardiomyocytes but cardiac fibroblasts 
express high levels of this protein Serum Gal-3 predicts short-, mid- and 
long-term mortality and HF-associated hospitalization in early and late 
stage HFpEF and HFrEF
sST2
Myocardial stress
In HF, ST2 mRNA and protein are upregulated and protein becomes 
detectable in serum. In severe chronic HF, change in serum sST2 
independently predicts mortality or transplant.
PIIINP 
Tissue remodeling / 
collagen synthesis
PIIINP is produced and secreted into the circulation upon collagen 
synthesis Increased baseline PIIINP levels are associated with increased 
risk of death in CHF patients and decreased in response to 
spironolactone or eplerenone
OPN
Inflammation / tissue 
remodelling
OPN mRNA and protein are hardly detectable in healthy myocardium, but 
becomes detectable upon cardiomyocyte and fibroblast injury. 
Abbreviations: CHF = chronic heart failure;  CRT = cardiac resynchronization therapy;  HFp/rEF = heart failure 
with preserved/reduced ejection fraction; NT-proBNP = N-terminal pro-peptide of brain natriuretic 
peptide; OPN = osteopontin;  PIIINP = N-terminal pro-peptide of collagen III
Local echocardiography examinations will be performed to capture at least all of the variables 
listed in Table 9–6. The recordings of echocardiography examinations will be digitally 
transferred to the vendor / echo core laboratory (ECL) for centralized interpretation and 
reporting. Echocardiography from videotape will be digitized, and analyses will be performed 
on an offline analysis workstation. Quantitative measures on all study echocardiographies will 
be performed by dedicated analysts at the core laboratory, who will be blinded to clinical 
information and randomized treatment assignment. The echocardiography results will not be 
provided to sites. 

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Table 9–6
Echocardiography sub-study: variables for evaluation
Variables
Details
LV structure, 
systolic function 
and geometry

Left ventricular ejection fraction (LVEF %) using modified Simpson’s biplane method

LV end-diastolic volume (LVEDV, mL), LVED volume index (LVEDVi [=LVEDV/body 
surface area (BSA)], mL/m2)

LV end-systolic volume (LVESV, mL), LVES volume index (LVESVi [=LVESV/BSA], 
mL/m2)

LV end-diastolic dimension (LVEDD, cm) and LV end-systolic diameter (LVESD, cm)

LV mass (LVM, g) and LV mass index (LVMi [LVM/BSA], g/m2)

Wall thicknesses, including inter-ventricular septum diameter (IVSd, cm) and LV 
posterior wall diameter (PWd, cm) in diastole

Relative wall thickness (RWT) defined as [2 x PWd] / LVEDD

LV geometry based on RWT and LVMi (normal, concentric remodelling, concentric 
hypertrophy or eccentric hypertrophy)
LV diastolic 
function

Left atrial size (LA diameter, cm; LA area, cm2), LA volume index (LAVi [=LA/BSA], 
mL/m2)

Early diastolic mitral annular velocity (e’, cm/s), using average calculated from:
o
Lateral e’ (early diastolic mitral annular relaxation velocity at lateral border of 
mitral annulus [by Tissue Doppler], cm/s) and
o
Septal e’ (early diastolic mitral annular relaxation velocity at septal border of 
mitral annulus [by Tissue Doppler], cm/s) 

E wave (mitral peak early diastolic transmitral flow velocity, m/s)

A wave (mitral peak late diastolic transmitral flow velocity, m/s) 

Ratio of E/A 

Ratio of E/e’ (using lateral e’, septal e’ and average e’)

E-wave deceleration time (EWDT, ms)
Right heart function

Pulmonary artery systolic pressure estimated by pressure gradient of tricuspid valve 
(PGTV) + estimated right atrial pressure (RAP)
o
PGTV [equivalent to peak RV-to-RA systolic gradient] = 4 x [tricuspid 
regurgitation velocity (VTR, m/s)]2
o
Estimated RAP depends on inferior vena cava diameter (IVCD, mm) and 
its respiratory collapsibility / change with respiration (end expiratory diameter 
[EED] - end inspiratory diameter / EED x 100, %) as well as the ratio of systolic to 
diastolic flow signals in the hepatic veins

Right heart function (using tricuspid annular plane systolic excursion [TAPSE], mm)
Other

Assessment of aortic and mitral valves for stenosis or regurgitation, using color or 
continuous wave Doppler  

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9.7.8.1.2
Biomarker sub-study 
At selected centers, the first approximately 500 subjects per study who consent to participate 
in Studies 17530 and 16244 will be invited to take part in a biomarker sub-study. Subject will 
be asked to sign a separate informed consent to participate in this sub-study.
For participating sites, samples for biomarkers will be drawn at Visit 1 (Day 1; baseline), 
at Visit 3 (Month 4), at yearly visits and at the end of the study (either at the PD Visit or the 
EOS Visit). The selected biomarkers studied are the ones believed to be relevant to the 
pathophysiology of the disease processes of CV and renal disease progression. The 
biomarkers studied are shown in Table 9–7.
Table 9–7
Biomarker sub-study: variables for evaluation
Biomarker
Mechanism
Rationale for assessing this biomarker
NT-proBNP
Cardiomyocyte 
pressure-volume 
overload
NT-proBNP is typically increased in subjects with 
asymptomatic or symptomatic left ventricular dysfunction 
and is associated with coronary artery disease and 
myocardial ischemia.
High sensitivity troponin T 
(hs-TnT)
Cardiomyocyte injury
Cardiac troponin T is independently associated with 
cardiovascular events and mortality in patients with CKD. 
Serum levels of hs-TnT reflect subclinical myocardial 
injury in ambulatory patients.
Cystatin C
Cystatin C level to have an important association with 
mortality across the GFR range
Neutrophil Gelatinase-
Associated Lipocalin 
(NGAL)
Renal tubuluar cells 
injury
Increased NGAL levels are an indicator of progression of 
renal damage in CKD patients even after adjustment for 
eGFR
9.7.8.1.3
Iohexol clearance sub-study - amended
This section was changed in Amendment 3, see Section 15.1.2.35.
At selected centers in Italy, at least 50 subjects per study consenting to participate in 
Studies 17530 and 16244 will be invited to take part in an iohexol clearance sub-study. 
Subjects will be asked to sign a separate informed consent to participate in this sub-study. 
Subjects who are included in this sub-study will have their GFR directly measured by the 
iohexol plasma clearance technique (43).
Iohexol plasma clearance will be assessed at Visit 1 (Day 1, baseline), at Visit 3 (Month 4) 
and thereafter at every other visit (i.e. every 8 months) until the end of the study (either at the 
PD Visit or the EOS Visit) plus an additional assessment at the PT Visit (recovery). The 
Iohexol results will not be provided to the sites.  

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The variables for evaluation in this sub-study are as follows:
−
Primary variable:
Chronic GFR slope, i.e. the rate of GFR decline from Visit 3 (Month 4) after 
randomization to the end of the treatment period.
As previously addressed in the AASK trial, this approach is needed to address the 
biphasic change in GFR decline that is expected after exposure to the study drug. 
The GFR slope will be determined separately during the first 4 months following 
randomization (acute slope) and after 4 months (chronic slope). The acute and chronic 
phases are differentiated because the study treatment might have acute effects on 
GFR that may differ from its long term effects on disease progression (44, 45)
(an approach approved by the U.S. National Institute of Diabetes and Digestive and 
Kidney Diseases (46)).
−
Exploratory variable:
o
Change in GFR from Visit 1 (baseline) and at the PT Visit (recovery)
o
Acute GFR changes from baseline to Visit 3 (Month 4)
o
Acute GFR changes from the end of the treatment period until the end of the 
recovery period
o
Correlation analyses between short term GFR changes between Visit 1 (baseline) 
and Visit 3 (Month 4) after randomization, and long term GFR decline (chronic 
slope).
An ANCOVA model will be fitted to the GFR efficacy variables including the factors 
treatment group, the stratification factors (type of albuminuria, eGFR category, history 
of CVD) and the baseline GFR as covariate. Corresponding two-sided 95% confidence 
intervals will be computed. In addition, correlation analyses between short term GFR 
changes between Visit 1 (baseline) and Visit 3 (Month 4) after randomization, and 
long term GFR decline (chronic slope).
9.8
Appropriateness of procedures / measurements
All parameters and their methods of measurement are standard variables / methods in 
clinical studies and / or clinical practice. They are widely used and generally recognized as 
reliable, accurate and relevant.

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10.
Statistical methods and determination of sample size
10.1
General considerations
Statistical analysis will be performed using SAS; the version used will be specified in the 
statistical analysis plan (SAP).
A log-normal distribution is assumed for serum creatinine and UACR. For all other metric 
variables, a normal distribution is assumed. The distributional assumptions will be 
investigated and if necessary, nonparametric methods or transformation of the data will be 
considered. 
All variables will be analyzed by descriptive statistical methods. The number of data 
available, mean, standard deviation (SDv), minimum, median, and maximum will be 
calculated for metric data. The geometric mean and SDv will be provided instead of the 
arithmetic mean and SDv for the variables where lognormal distributions are assumed. 
Frequency tables will be generated for categorical data.
Baseline values will be defined as the last non-missing measurement before randomization 
(Visit 1). If the last observation available prior to randomization is the measurement from the 
Screening Visit, this would be used as the baseline value. This also includes assessments from 
a local laboratory, in case that prior to randomization, no assessment from the central 
laboratory is available. Otherwise baseline will be missing. The measurement from the Run-in 
Visit will not be used as a baseline value. If more than one measurement was planned for a 
scheduled time point, for example blood pressure measurements and heart rate, the mean 
value of the last set of measurements per time point prior to randomization will be used as the 
baseline value.
Only the data provided by the central laboratory will be used for analysis, values from local 
laboratories will not be used in the statistical analysis and listed only. 
In the event of repeated measurements for Pre-treatment Visits and the Visit 1 (Day 1; baseline),
the closest measurement prior to randomization will be used for analysis instead of the 
scheduled measurements. At all visits post-randomization and unless stated otherwise, only 
the values at scheduled measurements will be used for analysis.
The derived visit ‘Any time post baseline’ (applicable for efficacy) will include any measurement 
after randomization, including unscheduled assessments. For the derived visit ‘Any time on 
treatment’, only assessments up to 30 days after last study drug administration, including 
unscheduled assessments, will be considered (applicable for efficacy; for safety, assessments 
within 3 days after last study drug administration will be considered).
Further details on the statistical analyses will be provided in the SAP that will be approved 
before database release. 

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10.2
Analysis sets - amended
This section was changed in Amendment 3, see Section 15.1.2.36.
Safety analysis set (SAF): 
All randomized subjects who have taken at least 1 dose 
of study drug 
Full analysis set (FAS): 
All randomized subjects 
Per-protocol analysis set (PPS): 
All subjects of the FAS without any validity findings
Pharmacokinetic analysis set (PKS): All finerenone-treated subjects with at least 1 valid 
finerenone plasma concentration and without protocol 
deviation, which would interfere with the evaluation of 
the PK data.
Listing only set (LOS):
All other subjects screened who did not receive any 
dose of study drug or for whom no data after beginning 
of treatment are available will be classified as LOS.  
Their data will be presented in the individual subject 
data listings but will not be included in any statistical 
analysis.
All subjects will be analyzed according to the planned treatment in FAS (the intent-to-treat or 
ITT principle). All subjects will be analyzed according to the actual treatment in SAF and PPS. 
If a subject receives both treatments due to a bottle error, the treatment actually received for 
the majority of the time in the study will be used in SAF and PPS.
The stratum variable type of albuminuria and eGFR category and history of CVD used in the 
statistical analysis will be derived based on the screening UACR and eGFR assessment, and 
medical history, respectively. All subjects will be analyzed according to their correct 
stratification category. In the event of stratification errors, the primary analysis will also be 
repeated based on the stratification category used in the randomization as a sensitivity 
analysis. 
10.3
Variables and planned statistical analyses
Disposition, baseline, history, demography and medication
10.3.1
The analyses of disposition, baseline, history and demography are described below:
10.3.1.1
Disposition - amended
This section was changed in Amendment 3, see Section 15.1.2.37.
The number of subjects enrolled, randomized and valid for the SAF, FAS, PPS and PKS will 
be summarized overall and by treatment group, country and investigator. The number of 
subjects discontinuing the treatment and follow-up epochs, together with the primary reason 
for discontinuation will be presented by treatment group and overall in separate tables. In 
addition, the number of subjects with important deviations and validity findings will be 

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presented overall, by investigator and country for each treatment group, and in total. The 
frequencies of each important deviation and validity finding will be presented by treatment 
group and in total.
10.3.1.2
Population characteristics
Population characteristics analyses, except for subject disposition, will be performed for the 
FAS, if not stated otherwise.
10.3.1.3
Demography and other baseline characteristics - amended
This section was changed in Amendment 3, see Section 15.1.2.38.
Demography includes age, sex, race, ethnicity, region (North America, Europe, Asia, Latin 
America and others), body weight, body height, BMI, hip and waist circumference, smoking 
history (never, former, current smoker) and alcohol consumption. Other baseline 
characteristics include baseline UACR, serum potassium, categories for serum potassium 
(≤4.5 mmol and > 4.5 mmol), eGFR (calculated by CKD-EPI formula), serum creatinine, 
HbA1c, values for vital signs parameters (i.e. systolic blood pressure, diastolic blood pressure 
and heart rate).
All demographic data and baseline characteristics will be tabulated by treatment group and 
overall. The demographic and other baseline characteristics table will also be presented, 
separated by each level of the stratification factors type of albuminuria, region and eGFR 
category and history of CVD.
The non-stratified demographic and other baseline characteristics table will be repeated for all 
other analysis sets if they differ in sample size from the FAS.
Demographics and other baseline characteristics will be presented for the FAS separately for 
the subjects belonging to PPS or not (only overall, not by treatment group).
10.3.1.4
Medical history
Medical history will be coded using the MedDRA dictionary. Medical history will be 
presented for each MedDRA Primary System Organ Class and Preferred Term by treatment 
group and overall in a summary table. Additional medical history terms by Standardized 
MedDRA Queries (SMQ) will also be presented.
10.3.1.5
Concomitant medication
Concomitant medication will be coded using the WHO Drug Dictionary (WHO-DD). The 
number of subjects who took at least one concomitant medication, the number of subjects 
who took at least one medication that started and ended before administration of study drug 
and the number of subjects who took at least one concomitant medication that started after 
start of study drug will be presented by treatment group and overall using ATC classes and 
subclasses. These tables will be repeated, summarizing the number of subjects with 
medication in the Bayer drug groups of interest (including ACEI, ARBs, beta-blocker, 
diuretics, potassium supplements, potassium lowering agents, alpha blocking agents, calcium 
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inhibitors and CYP3A4 inducers). A subject will be counted only once within each ATC class 
/ subclass or Bayer drug group, respectively.
A listing will be provided including all medication classified as a weak, moderate or strong 
CYP3A4 inhibitor according to the Bayer drug groupings together with the respective 
classification information.
Treatment duration, extent of exposure, up-titration status and 
10.3.2
compliance - amended
This section was changed in Amendment 3, see Section 15.1.2.39.
The analyses described in this section will be repeated for the SAF and PPS if they differ in 
sample size from the FAS.
Treatment duration (number of months with study drug intake) will be summarized using 
descriptive statistics by treatment group and overall. In addition, treatment duration will be 
categorized and presented with the corresponding number and percentage of subjects by 
treatment group and overall. Further specification of the categories will be provided in the 
SAP.
A table will be presented with the absolute and relative frequencies of subjects still in the 
study at each visit. Kaplan-Meier plots for ‘Time to end of study treatment’ will be provided. 
The extent of exposure to study drug (total amount of intake in grams) will be summarized 
using descriptive statistics by treatment group. 
The up-titration status (yes/no), regardless of actual or sham up-titration, will be summarized 
with absolute and relative frequencies per treatment group for each visit as well as subjects 
never up-titrated, up-titrated once, and up-titrated more than once. Compliance (as a percentage)
will be calculated as follows: 
100 * Number of taken tablets / Number of planned tablets.
The number of planned tablets will be calculated as follows:
(Days from randomization to last intake of study drug + 1) * Number of planned tablets per 
day.
All tablets, including the dummy placebo tablets, will be counted. For subjects who withdraw 
prematurely from the study drug, compliance will be calculated up to the time of last dose.
The compliance will be summarized descriptively by treatment group and overall. In addition, 
percent of compliance will be categorized into three groups, <80%, ≥80 to ≤120% and 
>120%, and the categories will be summarized by treatment group and overall.
Efficacy variables
10.3.3
The primary and secondary variables of efficacy are defined in Section 9.4.
10.3.3.1
Primary efficacy variable: primary analysis
The primary analysis of the primary efficacy variable will be performed in FAS.

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Randomized subjects without an event of the primary composite endpoint at the time of 
analysis will be censored at the date of their last visit or date of non-CV death. Subjects 
without information about the primary composite endpoint after baseline will be censored at 
Day 1.
In order to evaluate whether finerenone is superior to placebo in prolonging the time to the 
first event of the primary composite endpoint, the following null hypothesis will be tested 
using the log-rank test at an overall one-sided significance level of 2.5%, equivalently a 
two-sided significance level of 5%:
H0: Sfinerenone(t) = Splacebo (t) for all time points t ≥ 0
The alternative hypothesis will be:
H1: Sfinerenone (t) > Splacebo (t) for at least one time point t ≥ 0 and 
Sfinerenone (t) ≥Splacebo (t) for all time points t ≥ 0,
where Sfinerenone denotes the ‘survival’ function of the finerenone treatment group and 
Splacebo denotes the ‘survival’ function of the placebo treatment group. ‘Survival’ means 
‘no event of the primary composite endpoint’ in this context. 
The following decision rule to test the null hypothesis will be applied:
According to the size of this study it is justified to assume under H0 a sufficiently close 
approximation of the log-rank test (47) to the normal distribution. If the z-value from the log-
rank test (for the difference Sfinerenone – Splacebo), stratified by the stratification factors type of 
albuminuria, region, eGFR category and history of CVD is larger than the critical quantile 
from the normal distribution (z0.975 = 1.960), the null hypothesis will be rejected in favor of 
the alternative hypothesis.
The nominal significance levels and the critical values at the final analysis will be adjusted to 
account for the interim analysis, see Section 10.5 for more details.
In order to provide a point estimate of the hazard ratio and a corresponding two-sided 95% 
confidence interval, a stratified Cox proportional regression model will be used. 
Kaplan-Meier curves will be provided for the cumulative proportions of events by treatment 
groups.
10.3.3.2
Primary efficacy variable: supportive analyses
The primary analysis of the primary efficacy variable will be repeated in the PPS as a 
supportive analysis. Further supportive analyses of the primary efficacy variable will be 
performed in the FAS and PPS.
The absolute and relative frequency of subjects with an event of the primary composite 
endpoint until 6, 12, 18, 24, 30 and 36 months will be displayed overall and by treatment 
group. The number of individual events of the primary composite endpoint until 6, 12, 18, 24, 
30 and 36 months will be displayed overall and by treatment group. Frequencies will be 
calculated for the number of individual events of the primary composite endpoint per subject 
until 6, 12, 18, 24, 30 and 36 months overall and by treatment group.

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Kaplan-Meier estimates (the 25th, 50th and 75th percentile) of the time to the first event of the 
primary composite endpoint (including 95% confidence interval), overall ‘survival’ rates at 
6, 12, 18, 24, 30 and 36 months and Kaplan-Meier curves will be presented for each treatment 
group. These analyses will be presented in total and for each level of the stratification factors 
(type of albuminuria, region, eGFR category, history of CVD). 
The censoring mechanism of subjects without an event of the primary composite endpoint at 
the time of analysis is assumed to be non-informative for the primary efficacy analysis. 
Sensitivity analyses will be performed, assessing the impact of potential informative 
censoring of such subjects. These will include the use of different imputation rules for 
considering subjects without an event of the primary composite endpoint as having an event 
or being censored, and will be further outlined in the SAP. 
For the individual events of the primary composite endpoint, the number of events per 
patient-year will be presented overall and by treatment group. The frequency of events per 
patient-year for a treatment group will be calculated as the number of events observed for a 
treatment group (counting all events, not only the first one) divided by the sum of the days 
from first intake of study drug for all subjects within a treatment group and multiplied by 
365.25.
An ‘on-treatment’ analysis will be performed, including only events occurring while taking 
study drug or until 30 days after stop of study drug. This analysis will be performed in the 
FAS.
10.3.3.3
Secondary efficacy variables: primary analysis
The primary analysis of the secondary efficacy variables will be analyzed in FAS.
If the null hypothesis of the primary analysis is rejected, the secondary efficacy variables will 
be tested hierarchically in the order as they are listed in Section 9.4.2, while keeping the 
two-sided significance level of 5.0%. Otherwise, the testing of the secondary efficacy 
variables will be performed in an explorative manner only. 
The primary analysis of the secondary time-to-event endpoints will be analyzed analogously 
to the primary analysis of the primary composite endpoint.
An ANCOVA model will be fitted to the logarithmized ratios of UACR at Month 4 to UACR 
at baseline including the factors treatment group, the stratification factors (type of 
albuminuria, region, eGFR category, history of CVD) and the logarithmized baseline UACR 
as covariate.  Corresponding two-sided 95% confidence intervals will be computed.  This is 
consistent with the primary analysis of the Phase II Study 16243.
10.3.3.4
Secondary efficacy variables: supportive analyses
The primary analysis of the secondary efficacy variables will be repeated in the PPS as a 
supportive analysis. Further supportive analyses of the secondary efficacy variables will be 
performed in FAS and PPS.

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The supportive analysis of the secondary time-to-event endpoints will be analyzed in the same 
way as that for the primary composite endpoint, UACR at Month 4 will be analyzed using an 
ANCOVA as described above. 
10.3.3.5
Analysis of other exploratory efficacy variables
All other efficacy variables will be analyzed in FAS and PPS in an explorative manner. 
10.3.3.5.1
UACR and albuminuria - amended
This section was changed in Amendment 3, see Section 15.1.2.40.
UACR during the study will be summarized descriptively by treatment group and visit 
including ratios to baseline. These analyses will be performed overall and separated by the 
stratification factors (type of albuminuria, region and eGFR category, history of CVD). 
The log-transformed ratio of UACR to baseline at each visit up to Month 24 will be analyzed 
by a mixed model with the factors treatment group, visit, treatment by visit interaction,
factors for the stratification levels (type of albuminuria, region and eGFR category, history of 
CVD), log-transformed baseline value as covariate nested within type of albuminuria and 
log-transformed baseline value by visit interaction. Pairwise ratios between the finerenone 
and the placebo treatment group will be calculated and corresponding two-sided 95% 
confidence intervals will be computed.
Frequency tables will be generated for the number of subjects with a relative decrease and 
increase in UACR of ≥30%, ≥40% and ≥50% from baseline UACR. The analysis will be 
performed for each visit and for any time post baseline. The analysis will also be performed 
stratified for each level of the stratification factors (type of albuminuria, region and eGFR 
category, history of CVD).
A shift table will be provided displaying the number of subjects who changed from baseline 
to each visit from very high albuminuria to high albuminuria, from very high albuminuria to 
UACR < 30mg/g, from high albuminuria to UACR < 30mg/g, from high albuminuria to very 
high albuminuria and from UACR < 30mg/g to high and very high albuminuria by treatment 
group and overall. The albuminuria category changes will only be considered as shifts, if they 
are accompanied by a UACR decrease of at least 30% from baseline to each visit.
The additional categorical UACR efficacy variables listed in Section 9.4.3 will be 
summarized for presence or absence of the event using logistic regression with the factors 
treatment group and stratification levels (type of albuminuria, region and eGFR category, 
history of CVD). Pairwise differences between the finerenone and the placebo treatment 
group will be calculated and corresponding two-sided 95% confidence intervals will be 
computed.
10.3.3.5.2
Decrease in eGFR
eGFR will be summarized descriptively by treatment group and visit including absolute and 
relative changes to baseline. These analyses will be performed overall and separated by the 
stratification factors (type of albuminuria, region and eGFR category, history of CVD). 

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The absolute change of eGFR to baseline at each visit until Month 24 will be analyzed by a 
mixed model with the factors treatment group, visit, treatment by visit interaction, factors for 
the stratification levels (type of albuminuria, region and eGFR category, history of CVD), 
baseline value as covariate nested within eGFR category and baseline by visit interaction. 
Pairwise differences between the finerenone and the placebo treatment group will be 
calculated and corresponding two-sided 95% confidence intervals will be computed.
Frequency tables will be generated for the number of subjects with a relative decrease in 
eGFR of ≥30%, ≥40%, ≥50% and ≥57% from baseline eGFR. The analysis will be performed 
for each visit and for any time post baseline. In addition, for each patient, the annual change 
in eGFR will be calculated by fitting the patient’s eGFR assessments into a linear regression 
model with time as the independent variable. The derived annual change will be analyzed 
using an ANCOVA model including baseline, treatment group and stratification factors as 
fixed-effects.
10.3.3.5.3
Health-related quality of life (HRQoL)
Domain scores for each of the 5 domains (Physical Component Summary, Mental Component 
Summary, Burden of Kidney Disease, Symptoms / Problems, and Effects of Kidney Disease) 
will be calculated according to the KDQOL scoring instruction
(http://www.rand.org/health/surveys_tools/kdqol.html [6th September 2013]). The KDQOL-
36 domain scores will be presented by visit and treatment group by means of number of 
observations, number of missing values, minimum, first quartile, mean, SDv, median, third 
quartile, and maximum, including the changes from baseline. 
Summary scores will be calculated out of the 5 dimensions according to the scoring 
instructions from Europe and the US [refer to the EQ-5D-5L User Guide (48) and to the 
EQ-5D Value Sets (49)]. The values and the changes from baseline of the summary scores 
and the EQ Visual Analogue scale (VAS) will be summarized by treatment group and visit 
using the same descriptive statistics as for KDQOL. 
For details on HRQoL questionnaires, see Section 16.3
10.3.3.5.4
New diagnosis of atrial fibrillation, new diagnosis of heart failure 
and regression of albuminuria
These other exploratory efficacy variables will be summarized for presence or absence of the 
event using logistic regression with the factors treatment group and stratification levels (type 
of albuminuria, region and eGFR category, history of CVD). Pairwise differences between the 
finerenone and the placebo treatment group will be calculated and corresponding two-sided 
95% confidence intervals will be computed.
10.3.3.6
Subgroup analyses
Exploratory subgroup analyses are planned for the primary efficacy variable, also the 
secondary efficacy variables.  This will include descriptive statistics and a statistical test for 
interaction.

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The following subgroups will be considered for exploratory subgroup analyses:

Region (North America, Latin America, Europe, Asia, Others)

eGFR category at screening and baseline (eGFR 25 to < 45, 45 to < 60 and 
≥60 mL/min/1.73m2)

Type of albuminuria at screening and baseline (high albuminuria vs very high 
albuminuria) 

History of CVD (present, absent)

Baseline serum potassium (≤ 4.5 vs. > 4.5 mmol/L)

Systolic blood pressure at baseline (90 to <130 , 130 to <160 and ≥ 160 mmHg).
It is anticipated that in these proposed subgroups for analysis, differences in treatment effects 
may be observed according to the screening or baseline characteristics defined, due in part to 
the differences in the risk of clinical events expected in the different subgroups.
Furthermore, subgroup analysis usually required will be performed, including the following 
subgroups:

Race

Gender

Age group.
Safety variables
10.3.4
All analyses on safety and tolerability data will be performed in the SAF.
The following safety variables will be assessed during the study:

SAEs and AEs leading to discontinuation of treatment with study drug

Change in body weight

Change in serum potassium from baseline

Number of subjects with hyperkalemia (serum potassium > 5.5 mmol/L)

Number of subjects with severe hyperkalemia (serum potassium > 6.0 mmol/L)

Number of subjects with hospitalization for hyperkalemia

Number of subjects discontinuing study drug permanently due to hyperkalemia

Change in vital signs from baseline

Change in renal function measured by eGFR (CKD-EPI) change from baseline

Number of subjects with hospitalization for worsening of renal function

Number of subjects discontinuing study drug permanently due to worsening of 
renal function

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
Changes in laboratory values.
10.3.4.1
Adverse events
Adverse events (AEs) will be coded using the Medical Dictionary for Regulatory Activities 
(MedDRA, latest version available prior to data base freeze). A listing will be provided 
linking the original investigator terms and the coded terms. AEs will also be presented 
grouped by SMQs. 
AEs that started or worsened after the first dose of study drug up to 3 days after any 
temporary or permanent interruption of study drug will be considered as treatment emergent 
AEs (TEAEs). 
An overall summary of all AEs and TEAEs will be generated by treatment group. 
The number of subjects with TEAEs, post-treatment AEs occurring more than 3 days after 
stop of study drug, treatment-emergent SAEs, treatment-emergent study drug-related AEs, 
treatment-emergent study drug-related SAEs, TEAEs causing permanent discontinuation of
study drug, treatment-emergent non-serious AEs, non-serious AEs, TEAEs by maximum 
intensity, treatment-emergent SAEs by maximum intensity, drug-related TEAEs by maximum 
intensity, TEAEs by worst outcome and treatment-emergent SAEs by worst outcome will be 
summarized by treatment group using MedDRA terms grouped by Primary System Organ 
Class and Preferred Term. 
In case of events with different intensity within a subject, the maximum reported intensity 
will be used. If intensity is missing, the event will be considered as severe. If the same event 
is reported as both unrelated and related to the study drug within a subject, the event will be 
reported as related to study drug. If the drug relationship is missing, the event will be 
considered as being related to the study drug.
Separate tables summarizing TEAEs, treatment-emergent study drug-related AEs, and SAEs 
that occurred in more than 5% of the subjects will be provided.
Deaths, SAEs and AEs leading to permanent study drug discontinuation will be listed 
separately.
10.3.4.2
Laboratory data
The number of subjects with treatment emergent (until 3 days after any temporary or 
permanent interruption of study drug) abnormal laboratory values above or below the normal 
range will be tabulated by the laboratory parameter and treatment group. 
Summary statistics including changes to baseline will be calculated by treatment group and 
visit for all quantitative laboratory parameters, e.g. for hematology, HBA1c, clinical chemistry 
and urinalysis. Geometric statistics and ratios to baseline will be presented for creatinine 
instead of arithmetic statistics with changes from baseline. For eGFR the relative change will 
be displayed in addition to the absolute change from baseline.
Summary statistics for serum potassium, eGFR and serum creatinine will also be repeated by 
treatment group and visit separately for each level of the stratification factors (type of 
albuminuria, region and eGFR category, history of CVD). 

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The following special safety parameters will be further assessed by displaying the number of 
subjects with safety events as described below by treatment group, visit and for any time on 
treatment (including unscheduled assessments) and up to 3 days after last study drug 
administration. This will also be performed by stratification factors. The summaries will be 
performed for the number of subjects with

Absolute value of serum potassium  >5.5 mmol/L and >6 mmol/L 

Relative decrease from baseline in eGFR of ≥30%, ≥40%, ≥50% and ≥57%, also 
sustained decrease over 4 weeks

Absolute value of eGFR < 30 mL/min/1.73m².
The percentage of subjects with the respective events (non-stratified) at any time 
post-baseline (including unscheduled assessments) and within 3 days after last study drug 
administration will be compared between the finerenone and the placebo treatment group by 
applying separate explorative χ² tests with continuity correction. If the expected number of 
subjects in at least 1 cell of the 2x2 contingency table is <5 (50), Fisher’s exact test will be 
applied instead of the ² test. Estimates and two-sided 95% confidence intervals will be 
provided for each treatment group and the treatment differences. Clopper Pearson confidence 
intervals will be calculated for each treatment group, while for treatment differences the exact 
unconditional confidence limits will be calculated.
10.3.4.3
Vital signs
At the corresponding visits, 3 measurements of vital signs parameters will be taken in the 
sitting position with at least a 1-minute interval between each reading. Averages of 
non-missing values of these 3 measurements will be calculated and used for the statistical 
analysis. If only one of the planned measurements is available, this value will be used.
Vital signs values will be summarized by treatment group and visit using descriptive statistics 
including absolute changes from baseline. The analysis will be repeated for SBP stratified by 
baseline SBP >90 to <130 mmHg, 130 to <160 mmHg and ≥160 mmHg.
10.3.4.4
Weight and BMI
The values and the changes from baseline will be summarized by treatment group and visit 
using descriptive statistics for weight and BMI. 
10.3.4.5
Further safety variables
All safety variables are listed at the start of this section.  Not covered in the above sections is 
the presence or absence of events associated with hyperkalemia and renal failure. These will 
be summarized by treatment group using frequency counts.
Missing data / drop outs
10.3.5
A subject who has been randomized and discontinues study participation prematurely for any 
reason, either from study treatment or from follow-up, is defined as a ‘dropout’, even if 
no study drug has been taken. Dropouts will not be replaced. 

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Data from subjects who prematurely terminated the study will be used to the maximum extent 
possible.
All missing or partial data will be presented in the subject data listing as they are recorded on 
the electronic eCRF.
Sensitivity analyses using other imputation methods will be performed for the primary 
endpoint.
For further information on missing data, please refer to Section 11.4.
10.4
Determination of sample size - amended
This section was changed in Amendment 3, see Section 15.1.2.41.
This is an event-driven study. A total of between 970 and 976 primary efficacy endpoint events 
will have 90% power to demonstrate superiority of finerenone to placebo using a logrank test at 
a two-sided significance level of 5.0%, assuming a 20% relative risk reduction, i.e. a true hazard 
ratio of 0.80 (the hazard ratio that will be observed in the study will be different, i.e. closer to 1 
due to treatment discontinuations). The study will stop when approximately 976 primary 
efficacy endpoints accrue across both treatment arms.
With an assumed treatment duration of between 44 and 48 months (duration of recruitment 
period: 33 and 41 months, equal recruitment pattern during the accrual period, maximum 
treatment period of the last subject recruited: 11 and 7 months, respectively), the planned total 
number of subjects to be randomized is estimated to be between 6212 and 6286 subjects, 
respectively, assuming an annual placebo event rate of 8%, a common annual lost-to-follow-
up rate of 0.7% in both treatment groups, an annual finerenone discontinuation rate of 5% and 
assuming that placebo discontinuation will not change the hazard. 6400 subjects are planned 
to be randomized taking a certain ramp-up during recruitment into account. Assuming a 
screening failure rate of 50%, 12800 subjects are planned to be screened.
Due to the minimal effect of the interim analysis on the overall power of the study, an 
adjustment of sample size would be negligible. 
The assumption of the annual placebo event rate of 8% is based on the results from the 
MICRO-HOPE, RENAAL, IDNT, ALTITUDE and SAVOR-TIMI 53 trials. The latter 2 are 
more recent studies. Event rates were obtained from the respective studies in the arms where 
treatment would more closely resemble that in the placebo population of the CV-DKD study 
who will be on standard of care treatment for DKD. Annual event rates for the composite CV 
endpoint range from 7-10% for older studies and 5-6% for more recent studies. As the 
anticipated population study 17530 will be more enriched for CV outcomes than ALTITUDE 
and SAVOR-TIMI 53, a likely lower mean eGFR and higher median UACR value, the 
assumed annual placebo event rate of 8% is assumed to be appropriate for this Phase III 
setting (10, 11, 51-54). 
The calculations of the required total number of events and subjects to be randomized were 
performed using PASS 11 (55).

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10.5
Planned interim analyses - amended
This section was changed in Amendment 3, see Section 15.1.2.42.
One formal interim analysis is planned when 2/3 of the required total number of primary 
efficacy endpoint events have been observed. Based on the assumptions from sample size 
determination the interim analysis will take place between 34 and 38 months after start of 
study treatment. As an event-driven trial, the actual timing of the interim analysis will depend 
on the observed event rate, the patient recruitment rate, and length of the recruitment period.
If the interim analysis shows clear and consistent benefit in the finerenone treatment group, 
the DMC may recommend early study termination. The Haybittle-Peto rule will be used to 
guide the decision regarding early stopping of the study for success: a reduction of 3 standard 
deviations in the analysis of the primary efficacy endpoint and the secondary renal composite 
endpoint at the interim analysis (two-sided p-value < 0.00270). 
If the decision will be to stop the study early for success, the final primary analyses, both for 
the primary and secondary efficacy endpoints, will be performed at an overall two-sided
significance level of 0.270%. A group sequential design with a single interim analysis when 
2/3 of the information is available with a stopping rule of two-sided p < 0.00270 would 
require a final p < 0.04968 to maintain the overall significance level at 5%. Consequently, if 
the decision will be to continue the study without stopping early for success, the final primary 
analyses will be performed at a two-sided significance level of 4.968%.
For a lack of efficacy, a non-binding futility approach will be utilized at the time of the 
planned interim analysis. If the conditional probability of rejecting the null hypothesis for the 
primary comparison, given the assumed and current event rates, falls to an unacceptably low 
level (as will be specified in the DMC Charter), the DMC may consider recommending early 
termination of the study.
The Executive Committee will oversee overall blinded event rates to ensure that they meet 
protocol projections. If overall event rates are lower than expected, consideration will be 
given to altering the trial design, such as increasing the sample size or extending the study 
duration without knowledge of any treatment effect.
11.
Data handling and quality assurance
11.1
Data recording
The data collection tool for this study will be a validated electronic data capture system called 
RAVE. Subject data necessary for analysis and reporting will be entered/transmitted into a 
validated database or data system. 
Data required according to this protocol will be recorded by investigational site personnel via 
data entry into the internet-based electronic data capture software system RAVE, which Bayer 
has licensed from Medidata Solutions Worldwide. RAVE has been validated by Medidata 
Solutions Worldwide and Bayer for use in its clinical studies. RAVE allows for the 

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application of software logic to set-up data entry screens and data checks to ensure the 
completeness and accuracy of the data entered by the site personnel. Bayer extensively 
applies the logic to ensure data are complete and reflect the clinical data requirements of the 
study. Data queries resulting from the application of the software logic are resolved by the site 
personnel. The data are stored at a secure host facility maintained by Medidata Solutions 
Worldwide and transferred on a periodic basis to Bayer's internal computer system via a 
secure Virtual Private Network.
All access to the RAVE system is through a password-protected security system that is part of 
the RAVE software. All internal Bayer and external investigator site personnel seeking access 
must go through a thorough RAVE training process before they are granted access to RAVE 
for use in Bayer's clinical studies. Training records are maintained.
All personnel with access to the RAVE system are supported by a Service Desk staffed with 
trained personnel to answer questions and ensure access is maintained such that data entry can 
proceed in a timely manner.
The RAVE System contains a system-generated audit trail that captures any changes made to 
a data field, including who made the change, why the change was made and the date and time 
it was made. This information is available both at the investigator’s site and at Bayer. Data 
entries made in the RAVE EDC screens are supported by source documents maintained for all 
subjects enrolled in this study.
Source documentation
It is the expectation of the sponsor that key data entered into the eCRF has source 
documentation available at the site.
Study-specific data (race and ethnic group) may be entered directly into the CRF, without 
availability of corresponding source documentation.  For all other data, source documentation 
must be available at the site.
The site must implement processes to ensure availability of all required source 
documentation. A source document checklist (not part of this protocol) will be used at the site 
to identify the source data for key data points collected and the monitor will work with the site 
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Data recorded from screening failures
Data of ‘only screened subjects’ will be recorded at least as source data, as far as the reason 
for the premature discontinuation is identifiable. At minimum, the following data should be 
recorded in the eCRF:
Demographic information (subject number; year of birth / age; sex; if applicable race / 
ethnicity)
Date of informed consent
Reason for premature discontinuation
Date of last visit.
These data will be transferred to the respective database.
11.2
Monitoring
In accordance with applicable regulations, GCP, and sponsor’s/CRO’s procedures, monitors 
will contact the site prior to the start of the study to review with the site staff the protocol, 
study requirements, and their responsibilities to satisfy regulatory, ethical, and sponsor’s 
requirements. When reviewing data collection procedures, the discussion will also include 
identification and documentation of source data items.
The sponsor/designee will monitor the site activity to verify that the:

Data are authentic, accurate and complete. 

Safety and rights of subjects are being protected

Study is conducted in accordance with the currently approved protocol 
(including study treatment being used in accordance with the protocol)

Any other study agreements, GCP, and all applicable regulatory requirements are met.
The investigator and the head of the medical institution (where applicable) agrees to allow the 
monitor direct access to all relevant documents.
11.3
Data processing
Data will be collected as described in Section 11.1. Clinical data management will be 
performed in accordance with applicable sponsor’s/CRO’s standards and data cleaning 
procedures. This is applicable for data recorded on eCRF as well as for data from other 
sources (e.g. IxRS, laboratory, adjudication committees).
For data coding (e.g. AEs, medication), internationally recognized and accepted dictionaries 
will be used.

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11.4
Missing data 
All efforts will be made to collect complete data for all subjects randomized in this study. 
Subjects will be followed until the end of the study, and all required data will be collected, 
regardless of their compliance with study medication use or visit schedule.
After randomization, study drug discontinuation for any reason does not constitute withdrawal 
from the study and should not lead to the subject being withdrawn from the study. On the 
contrary, even subjects who have stopped taking study drug are expected to attend all the 
protocol specified study visits and will be encouraged to perform all assessments as stipulated 
in the visit schedule.
If it is not possible for a subject who has withdrawn from study drug to attend any visit(s) in 
person, the site staff will keep in touch with the subject by means of phone contact to the 
subject himself/herself, or to a person pre-designated by the subject, in accordance with the 
subject’s study visit schedule. Data will continue to be collected about the subject’s health 
status, including information on developing of renal or CV complications and vital status. 
This information may be provided either by the subject himself/herself, his/her general 
practitioner or a family relative (if allowed in the respective country). Data, such as 
information on survival and potential protocol-specified endpoints, might be also collected 
from a healthcare provider, from public or medical records, or other sources as available 
according to local guidelines and as allowed by local regulations. These data will be collected 
until the study is concluded, even if the subject no longer attends study visits in person, 
unless the subject withdrew consent and did not agree to release further information.
When an event date is not known, the site investigator will be asked to provide a best-estimate 
as to when the event occurred. Even though the exact date of an event is unknown, the 
investigator often has some information that would give an approximate date (e.g. the 
first week of a month, the fall of a year, or the middle of a particular year) or at least the 
date when the subject was last seen or contacted. This information can be meaningfully 
incorporated into the estimated date recorded, as this is likely to be closer to the true date than 
any produced by an uninformed computer algorithm. This estimated date should be the 
middle date within the period that the event is known to have occurred. If the event is known 
to have occurred in the first week of a month, then the date in the middle of that week should 
be recorded as the estimate. If it occurred in the fall of a year, then the middle date in the fall 
is the appropriate estimate. If no information is known, then the date in the middle of the 
plausible time period should be given, based on the last contact with the subject prior to the 
event and the date of contact when information about the event was known.
Data from subjects who prematurely terminate the study will be used to the maximum extent 
possible. All missing or partial data will be presented in the subject data listing as they are 
recorded on the eCRF. Data are collected primarily through an EDC system, which allows 
ongoing data entry and monitoring.
For those subjects who withdraw consent, sensitivity analyses will be performed to assess the 
impact of potential informative censoring of such subjects. These will include the use of 

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different imputation rules for considering subjects without an event of the primary composite 
endpoint as having an event or being censored.
11.5
Audit and inspection
To ensure compliance with GCP and regulatory requirements, a member of the sponsor’s (or a 
designated CRO’s) quality assurance unit may arrange to conduct an audit to assess the 
performance of the study at the study site and of the study documents originating there. The 
investigator/institution will be informed of the audit outcome.
In addition, inspections by regulatory health authority representatives and IEC(s)/IRB(s) are 
possible. The investigator should notify the sponsor immediately of any such inspection.
The investigator/institution agrees to allow the auditor or inspector direct access to all relevant 
documents and allocate his/her time and the time of his/her staff to the auditor/inspector to 
discuss findings and any issues. Audits and inspections may occur at any time during or after 
completion of the study.
11.6
Archiving
Essential documents shall be archived safely and securely in such a way that ensures that they 
are readily available upon authorities’ request.
Patient (hospital) files will be archived according to local regulations and in accordance with 
the maximum period of time permitted by the hospital, institution or private practice. Where 
the archiving procedures do not meet the minimum timelines required by the sponsor, 
alternative arrangements must be made to ensure the availability of the source documents for 
the required period.
The investigator/institution notifies the sponsor if the archival arrangements change (e.g. 
relocation or transfer of ownership).
The investigator site file is not to be destroyed without the sponsor’s approval.
The contract with the investigator/institution will contain all regulations relevant for the study site.
12.
Premature termination of the study
The sponsor has the right to close this study (or, if applicable, individual segments thereof 
[e.g. centers]) at any time, which may be due but not limited to the following reasons: 
If risk-benefit ratio becomes unacceptable owing to, for example,
Safety findings from this study (e.g. SAEs)
Results of any interim analysis
Results of parallel clinical studies

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Results of parallel animal studies 
(on e.g. toxicity, teratogenicity, carcinogenicity or reproduction toxicity).
If the study conduct (e.g. recruitment rate; drop-out rate; data quality; protocol compliance) 
does not suggest a proper completion of the trial within a reasonable time frame.
The investigator has the right to close his/her center at any time.
For any of the above closures, the following applies:
Closures should occur only after consultation between involved parties. Final decision 
on the closure must be in writing.
All affected institutions (e.g. IEC(s)/IRB(s); competent authority(ies); study center; 
head of study center) must be informed as applicable according to local law.
All study materials (except documentation that has to remain stored at site) must be 
returned to the sponsor. The investigator will retain all other documents until 
notification is given by the sponsor for destruction.
In the event of a partial study closure, ongoing subjects must be taken care of in an 
ethical manner.
Details for individual subject's withdrawal can be found in Section 6.4.1.
13.
Ethical and legal aspects
13.1
Investigator(s) and other study personnel
All other study personnel not included in this section are identified in a separate personnel list 
(not part of this clinical study protocol) as appropriate. This list will be updated as needed; an 
abbreviated version with personnel relevant for the centers will be available in each center’s 
investigator site file.
Whenever the term ‘investigator’ is noted in the protocol text, it may refer to either the 
principal investigator at the site, or an appropriately qualified, trained and delegated 
individual of the investigational site.
The principal investigator of each center must sign the protocol signature page and must 
receive all required external approvals (e.g. health authority, ethics committee, sponsor) 
before subject recruitment may start at the respective center. Likewise, all amendments to the 
protocol must be signed by the principal investigator and must have received all required 
external approvals before coming into effect at the respective center.
A complete list of all participating centers and their investigators, as well as all required 
signature documents, will be maintained in the sponsor’s study file.
The global sponsor of this study is identified on the title page of this protocol. If required by 
local law, local co-sponsors will be nominated; they will be identified on the respective 
country-specific signature pages.

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The coordinating investigators for this study are as follows:
 Spain
and
 USA
Executive Committee
13.1.1
The Executive Committee, which consists of external experts in the area of nephrology, 
diabetology and cardiology, will ensure the overarching integrity of the study. 
The Executive Committee will be established for Study 17530 and Study 16244. The 
committee’s responsibilities include the following: 

Review feedback from the independent DMC

Input into the Clinical Event Committee (CEC) charter

Provision of recommendations regarding sub-studies and amendments to the protocol

Contribution to and oversight of publications and communication of study results

Projecting study termination, and other study-related activities as appropriate

Overseeing overall blinded event rates to ensure that they meet protocol projections.
Decisions will be made by consensus; in the absence of consensus, the co-Chairs of the 
Executive Committee will provide their recommendation to the Sponsor for final determination.
Clinical Event Committee (CEC)
13.1.2
A Clinical Event Committee (CEC), blinded to study treatment assignment, will adjudicate all 
events that could potentially fulfill the criteria for the primary, secondary or other endpoints 
during the study. 
The CEC Charter will describe the roles and responsibilities of the CEC and define the events to 
be adjudicated and the manner in which they will be adjudicated. The CEC will judge whether 
an event meets the predetermined definitions. The co-Chairs of the CEC will be members of the 
Executive Committee established for Study 17530 and Study 16244.
All of the endpoint events shown in Table 13–1 will be reported to the CEC.
PPD
PPD

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Table 13–1
Endpoint events to be reported to the Clinical Event Committee (CEC)
●  Kidney failure
●  Decrease of eGFR of ≥40% from baseline, confirmed by at least one additional standardized 
measurement at least 4 weeks after the initial measurement
●  Decrease of eGFR of ≥57% from baseline, confirmed by at least one additional standardized 
measurement at least 4 weeks after the initial measurement
●  Decrease of eGFR to less than 15 mL/min/1.73m², confirmed by at least one additional 
standardized measurement at least 4 weeks after the initial measurement
●  CV and renal death events
●  Non-fatal myocardial infarction
●  Non-fatal stroke
●  Hospitalization for heart failure
●  Other CV hospitalization
●  New onset of atrial fibrillation or atrial flutter
Note:
Other endpoints of interest may be added. These will be specified in the CEC Charter.
The CEC will be responsible for classifying all death and hospitalization events and for 
determining whether pre-specified endpoint criteria were met for CV, renal or other fatal and 
non-fatal events. Sites are instructed to take a conservative approach when reporting 
endpoints; if the investigator suspects an endpoint may have occurred, it is best to report the 
event to the CEC for a final determination.
NOTE: reporting guidelines for AEs and SAEs as outlined in Sections 9.6.1.1 and 9.6.1.4
must be followed if the event is not a defined endpoint (see Table 13–1).
Data Monitoring Committee (DMC)
13.1.3
Ongoing safety monitoring during the conduct of the study will be performed by an external 
and independent DMC. An independent statistical analysis center (SAC) will be involved in 
processing unblinded safety data for the DMC. Analysis periods and procedures will be 
defined in an operational charter (DMC charter) filed in the study file. 
Outcome events as defined in Section 9.6.1.3.1 will not be reported as AEs or SAEs by the 
investigators; however, they will be collected in the eCRF. The independent DMC will 
periodically review and assess all outcome events as well as safety data from the study for 
imbalances in safety outcomes in an unblinded manner. It is believed that in this way, patient 
safety can continue to be monitored throughout the duration of the trial, and the integrity of the 
study maintained. If unexpected safety issues are identified, specific amendments will be 
implemented based on the recommendation of the DMC.
Following data review, the DMC will provide written recommendations that will be 
transferred to the chairmen of the Executive Committee and Bayer. DMC opinions and 
recommendations will be notified by Bayer as soon as possible to the competent authorities 
and the IECs where they qualify for expedited reporting.

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Steering Committee 
13.1.4
The Steering Committee will consist of country representative(s) and will be led by the 
Executive Committee. The Steering Committee will be blinded to the study data while the 
trial is ongoing. Their main responsibilities are as follows: 

Provide input to protocol-related issues and protocol amendments that may arise 
during the course of the study

Oversee study progress and provide recommendations to Executive Committee in 
regards to any necessary modifications that may be required in study conduct or study 
monitoring

Transmission of information to individual investigators

Serve as resource for scientific review of sub-studies, publications, presentations
and/or educational material as applicable.
13.2
Funding and financial disclosure
Funding
This study will be funded by its sponsor.
Financial disclosure 
Each investigator (including principal and/or any sub investigators) who is directly involved 
in the treatment or evaluation of research subjects has to provide a financial disclosure 
according to all applicable legal requirements. All relevant documentation will be filed in the 
trial master file.
13.3
Ethical and legal conduct of the study
The procedures set out in this protocol, pertaining to the conduct, evaluation, and 
documentation of this study, are designed to ensure that the sponsor and investigator abide by 
Good Clinical Practice (GCP) guidelines and the guiding principles detailed in the 
Declaration of Helsinki. The study will also be carried out in keeping with applicable local 
law(s) and regulation(s).
Documented approval from appropriate IEC(s)/IRBs will be obtained for all participating 
centers/countries before start of the study, according to GCP, local laws, regulations and 
organizations. When necessary, an extension, amendment or renewal of the IEC/IRB approval 
must be obtained and also forwarded to the sponsor. The responsible unit (e.g. IEC/IRB, head 
of the study center/medical institution) must supply to the sponsor, upon request, a list of the 
EC/IRB members involved in the vote and a statement to confirm that the IEC/IRB is 
organized and operates according to GCP and applicable laws and regulations.

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Strict adherence to all specifications laid down in this protocol is required for all aspects of 
study conduct; the investigator may not modify or alter the procedures described in this 
protocol. 
Modifications to the study protocol will not be implemented by either the sponsor or the 
investigator without agreement by both parties. However, the investigator or the sponsor may 
implement a deviation from, or a change of, the protocol to eliminate an immediate hazard(s) 
to the trial subjects without prior IEC/IRB/sponsor approval/favorable opinion. As soon as 
possible, the implemented deviation or change, the reasons for it and if appropriate the 
proposed protocol amendment should be submitted to the IEC/IRB/head of medical 
institution/sponsor. Any deviations from the protocol must be explained and documented by 
the investigator.
Details on discontinuation of the entire study or parts thereof can be found in Section 12.
13.4
Subject information and consent
All relevant information on the study will be summarized in an integrated subject information 
sheet and informed consent form provided by the sponsor or the study center. A sample 
subject information and informed consent form will be provided as a document separate to 
this protocol.
Based on this subject information sheet, the investigator or designee will explain all relevant 
aspects of the study to each subject / legal representative or proxy consenter (if the subject is 
under legal protection), prior to his/her entry into the study (i.e. before any examinations and 
procedures associated with the selection for the study are performed or any study-specific data 
is recorded on study-specific forms).
The investigator will also mention that written approval of the IRB/IEC has been obtained.
Each subject / legal representative or proxy consenter will be informed about the following 
aspects of premature withdrawal:

Each subject has the right to withdraw from the study at any time without any 
disadvantage and without having to provide reasons for this decision. 

The subject’s consent covers end-of-study examinations as specified in the visit 
description described in Section 9.2 to be conducted after withdrawal of consent. 

The subject’s data that have been collected until the time of withdrawal will be 
retained and statistically analyzed in accordance with the statistical analysis plan. 

Subject-specific data on the basis of material obtained before withdrawal may be 
generated after withdrawal (e.g. image reading, analysis of biological specimen such 
as blood, urine or tissues); these data would also be retained and statistically analyzed 
in accordance with the statistical analysis plan. The subject has the right to object to 
the generation and processing of this post-withdrawal data. For this, he/she needs to 
sign a corresponding declaration of objection; alternatively, the subject’s oral 
objection may be documented in the subject’s source data.

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Each subject / legal representative or proxy consenter will have ample time and opportunity to 
ask questions.
Only if the subject / legal representative or proxy consenter voluntarily agrees to sign the 
informed consent form and has done so, may he/she enter the study. Additionally, the 
investigator will personally sign and date the form. The subject / legal representative or proxy 
consenter will receive a copy of the signed and dated form.
The signed informed consent statement is to remain in the investigator site file or, if locally 
required, in the subject’s note/file of the medical institution.
In the event that informed consent is obtained on the date that baseline study procedures are 
performed, the study record or subject’s clinical record must clearly show that informed 
consent was obtained prior to these procedures.

If the subject is not capable of providing a signature, a verbal statement of consent can 
also be given in the presence of an impartial witness (independent of the sponsor and 
the investigator). This is to be documented by a signature from the informing 
physician as well as by a signature from the witness.

For adults under legal protection, consent shall be given by the legal guardian(s). The 
consent of an adult under legal protection shall also be requested where such a person 
is able to express his/her own will. His/her refusal or the withdrawal of his/her consent 
may not be disregarded.
The informed consent form and any other written information provided to subjects / legal 
representatives or proxy consenters will be revised whenever important new information 
becomes available that may be relevant to the subject’s consent, or there is an amendment to 
the protocol that necessitates a change to the content of the subject information and / or the 
written informed consent form. The investigator will inform the subject / legal representative 
or proxy consenter of changes in a timely manner and will ask the subject to confirm his/her 
participation in the study by signing the revised informed consent form. Any revised written 
informed consent form and written information must receive the IEC/IRB`s approval / 
favorable opinion in advance of use.
13.5
Publication policy and use of data
The sponsor has made the information regarding the study protocol publicly available on the 
internet at www.clinicaltrials.gov. 
All data and results and all intellectual property rights in the data and results derived from the 
study will be the property of the sponsor who may utilize them in various ways, such as for 
submission to government regulatory authorities or disclosure to other investigators.
Regarding public disclosure of study results, the sponsor will fulfill its obligations according 
to all applicable laws and regulations. The sponsor is interested in the publication of the 
results of every study it performs. 

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The sponsor recognizes the right of the investigator to publish the results upon completion of 
the study. However, the investigator, whilst free to utilize study data derived from his/her 
center for scientific purposes, must obtain written consent of the sponsor on the intended 
publication manuscript before its submission. To this end, the investigator must send a draft 
of the publication manuscript to the sponsor within a time period specified in the contract. 
The sponsor will review the manuscript promptly and will discuss its content with the 
investigator to reach a mutually agreeable final manuscript. 
13.6
Compensation for health damage of subjects / insurance
The sponsor maintains clinical trial insurance coverage for this study in accordance with the 
laws and regulations of the country in which the study is performed.
13.7
Confidentiality
All records identifying the subject will be kept confidential and, to the extent permitted by the 
applicable laws and/or regulations, will not be made publicly available.
Subject names will not be supplied to the sponsor. Only the subject number will be recorded 
in the eCRF, and if the subject name appears on any other document (e.g. pathologist report), 
it must be obliterated before a copy of the document is supplied to the sponsor. Study findings 
stored on a computer will be stored in accordance with local data protection laws. As part of 
the informed consent process, the subjects will be informed in writing that representatives of 
the sponsor, IEC/IRB, or regulatory authorities may inspect their medical records to verify the 
information collected, and that all personal information made available for inspection will be 
handled in strictest confidence and in accordance with local data protection laws.
If the results of the study are published, the subject’s identity will remain confidential.
The investigator will maintain a list to enable subjects to be identified.
14.
Reference list 
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Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, et 
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Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 
2012 clinical practice guideline for the evaluation and management of chronic kidney 
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Shlipak M. Diabetic nephropathy: preventing progression. Clin Evid (Online). 
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Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. 
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Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, et al. 
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Diabetes. 2014.
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Aldigier JC, Kanjanbuch T, Ma LJ, Brown NJ, Fogo AB. Regression of existing 
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Greene EL, Kren S, Hostetter TH. Role of aldosterone in the remnant kidney model in 
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blockade reduces vascular injury in stroke-prone hypertensive rats. Hypertension. 
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Silvestre JS, Robert V, Heymes C, Aupetit-Faisant B, Mouas C, Moalic JM, et al. 
Myocardial production of aldosterone and corticosterone in the rat. Physiological 
regulation. J Biol Chem. 1998;273(9):4883-91.
17.
Staessen J, Lijnen P, Fagard R, Verschueren LJ, Amery A. Rise in plasma 
concentration of aldosterone during long-term angiotensin II suppression. J 
Endocrinol. 1981;91(3):457-65.
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Fritsch Neves M, Schiffrin EL. Aldosterone: a risk factor for vascular disease. Curr 
Hypertens Rep. 2003;5(1):59-65.
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Funder JW. Eplerenone: hypertension, heart failure and the importance of 
mineralocorticoid receptor blockade. Future Cardiol. 2006;2(5):535-41.

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preventing the progression of chronic kidney disease. Cochrane Database Syst Rev. 
2014;4:CD007004.
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Shavit L, Lifschitz MD, Epstein M. Aldosterone blockade and the mineralocorticoid 
receptor in the management of chronic kidney disease: current concepts and emerging 
treatment paradigms. Kidney Int. 2012;81(10):955-68.
22.
Nappi JM, Sieg A. Aldosterone and aldosterone receptor antagonists in patients with 
chronic heart failure. Vasc Health Risk Manag. 2011;7:353-63.
23.
Kolkhof P, Delbeck M, Kretschmer A, Steinke W, Hartmann E, Barfacker L, et al. 
Finerenone, a novel selective nonsteroidal mineralocorticoid receptor antagonist 
protects from rat cardiorenal injury. J Cardiovasc Pharmacol. 2014;64(1):69-78.
24.
Pitt B, Kober L, Ponikowski P, Gheorghiade M, Filippatos G, Krum H, et al. Safety 
and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 
94-8862 in patients with chronic heart failure and mild or moderate chronic kidney 
disease: a randomized, double-blind trial. Eur Heart J. 2013;34(31):2453-63.
25.
Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, et al. 
Diabetic kidney disease: a report from an ADA Consensus Conference. Diabetes Care. 
2014;37(10):2864-83.
26.
Lambers Heerspink HJ, Chertow GM, Akizawa T, Audhya P, Bakris GL, Goldsberry 
A, et al. Baseline characteristics in the Bardoxolone methyl EvAluation in patients 
with Chronic kidney disease and type 2 diabetes mellitus: the Occurrence of renal 
eveNts (BEACON) trial. Nephrol Dial Transplant. 2013;28(11):2841-50.
27.
Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of 
spironolactone on morbidity and mortality in patients with severe heart failure. 
Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 
1999;341(10):709-17.
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Zannad F, McMurray JJ, Drexler H, Krum H, van Veldhuisen DJ, Swedberg K, et al. 
Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval 
Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail. 2010;12(6):617-22.
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Matsumoto Y, Mori Y, Kageyama S, Arihara K, Sugiyama T, Ohmura H, et al. 
Spironolactone reduces cardiovascular and cerebrovascular morbidity and mortality in 
hemodialysis patients. J Am Coll Cardiol. 2014;63(6):528-36.
30.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and 
the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 
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31.
Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJ, Mann JF, 
et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and 
prevention. Lancet. 2013;382(9889):339-52.
32.
Ninomiya T, Perkovic V, de Galan BE, Zoungas S, Pillai A, Jardine M, et al. 
Albuminuria and kidney function independently predict cardiovascular and renal 
outcomes in diabetes. J Am Soc Nephrol. 2009;20(8):1813-21.
33.
Heerspink HJ, de Zeeuw D. Are post-trial observational studies useful? J Am Soc 
Nephrol. 2014;25(10):2148-50.

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de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. 
Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic 
patients with nephropathy. Circulation. 2004;110(8):921-7.
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American Diabetes Association. Standards of Medical Care in Diabetes - 2010. 
2010;33(S11-S61).
36.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A 
new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-
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Horio M, Imai E, Yasuda Y, Watanabe T, Matsuo S. Modification of the CKD 
epidemiology collaboration (CKD-EPI) equation for Japanese: accuracy and use for
population estimates. Am J Kidney Dis. 2010;56(1):32-8.
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(KDOQI). KDOQI Clinical Practice Guidelines and Clinical Practice 
Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 
2007;49(2 Suppl 2):S12-154.
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Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure 
lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA. 
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Group AS, Cushman WC, Evans GW, Byington RP, Goff DC, Jr., Grimm RH, Jr., et 
al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J 
Med. 2010;362(17):1575-85.
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Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. 
KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic 
Kidney Disease. Kidney Int Suppl, 2 (2012), pp. 337–414.
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Kottgen A, Russell SD, Loehr LR, Crainiceanu CM, Rosamond WD, Chang PP, et al. 
Reduced kidney function as a risk factor for incident heart failure: the atherosclerosis 
risk in communities (ARIC) study. J Am Soc Nephrol. 2007;18(4):1307-15.
43.
Gaspari F, Perico N, Ruggenenti P, Mosconi L, Amuchastegui CS, Guerini E, et al. 
Plasma clearance of nonradioactive iohexol as a measure of glomerular filtration rate. 
J Am Soc Nephrol. 1995;6(2):257-63.
44.
Hall WD, Kusek JW, Kirk KA, Appel LJ, Schulman G, Agodoa LY, et al. Short-term 
effects of blood pressure control and antihypertensive drug regimen on glomerular 
filtration rate: the African-American Study of Kidney Disease and Hypertension Pilot 
Study. Am J Kidney Dis. 1997;29(5):720-8.
45.
Agodoa LY, Appel L, Bakris GL, Beck G, Bourgoignie J, Briggs JP, et al. Effect of 
ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a 
randomized controlled trial. JAMA. 2001;285(21):2719-28.
46.
Wright JT, Jr., Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, et al. Effect 
of blood pressure lowering and antihypertensive drug class on progression of 
hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288(19):2421-
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Collett D. Modelling Survival Data in Medical Research. 2nd ed: Chapman & 
Hall/CRC; 2003.
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The EuroQol Group. EQ-5D-3L User Guide. EUROQOL GROUP 2011; 2011.

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Szende A OM, Devlin N,, editor. EQ-5D Value Sets: Inventory, Comparative Review 
and User Guide. Dordrecht, Netherlands: Springer; 2007.
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Agresti A, editor. An Introduction to Categorical Data Analysis. 2nd ed. New York: 
John Wiley & Sons; 2007.
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Gerstein HC. Effects of ramipril on cardiovascular and microvascular outcomes in 
people with diabetes mellitus: results of the HOPE study and MICRO-HOPE 
substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. 
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Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria 
and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic 
individuals. JAMA. 2001;286(4):421-6.
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Parving HH, Brenner BM, McMurray JJ, de Zeeuw D, Haffner SM, Solomon SD, et 
al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med. 
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Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N 
Engl J Med. 2013;369(14):1317-26.
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Barotfi S, Molnar MZ, Almasi C, Kovacs AZ, Remport A, Szeifert L, et al. Validation 
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Martin CR, Thompson DR. Prediction of quality of life in patients with end-stage 
renal disease. Br J Health Psychol. 2000;5(1):41-55.

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15.
Protocol amendments
15.1
Amendment 3
Amendment 3 is the first global amendment dated 02 MAY 2017. The following is an 
overview of the changes made to the original Protocol Version 1.0.
Overview of changes to the study
15.1.1
The original protocol for this study was amended for the following reasons:
1) To account for the lower than expected recruitment rate, the duration of study and the 
number of sites required worldwide were increased.
2) To allow re-screening at an earlier stage and even if the reason for initial screen failure 
was an elevated blood potassium value, the re-screening rules were amended.
3) To allow randomization of patients with a recent CVD episode (i.e. those suffering 
from stroke, transient ischemic cerebral attack, acute coronary syndrome or 
hospitalization for worsening heart failure in the last 30 days prior to the Screening 
visit), the respective Exclusion criterion (#7) was modified.
4) In order to allow up-titration of study drug at any time during the study (from Visit 2 
onwards), the instructions for up-titration were modified. Additionally, a requirement 
to specify the reason for not dispensing the 20 mg dose in the eCRF was added.
5) The recommended blood pressure targets after randomization were updated according 
to the most recent literature.
6) Definitions of the endpoint “kidney failure” and the definitions of cardiovascular 
disease history for stratification purposes were added.
7) Administrative changes: 
Sponsor name was updated (Bayer AG became the sponsor for ongoing Bayer 
HealthCare AG sponsored studies on 1st July 2016), Sponsor for US territory was 
added, contact details for Sponsor’s medical expert were updated, and terminology 
changes due to updated Operating Instructions (“protocol deviation” was replaced by 
“validity finding”) were made. 
8) To improve clarity and correct typographical errors or inconsistencies.
Sections affected include:

Section 1 Title page

Synopsis

Section 5 Study design

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
Section 6.2 Exclusion criteria

Section 6.4.1.1 Discontinuation of study drug

Section 6.4.2.1 Re-screening

Section 7.3 Treatment assignment

Section 7.4 Dosage and administration

Section 7.5.2 Unblinding

Section 8.1.3 Control of blood pressure

Table 9-1 Study 17530: schedule of activities and evaluations

Table 9-2 Sub-studies of Study 17530: schedule of procedures

Section 9.2 Visit description

Section 9.2.1 Run-in Visit (4 to 16 weeks prior to the Screening Visit)

Section 9.2.2 Screening Visit (≤2 weeks prior to Visit 1)

Section 9.2.3 Visit 1 (randomization; Day 1 and baseline)

Section 9.2.5 Visit 3 (Month 4)

Section 9.2.6 Visit 4, 6, 7, 9, etc. (every 4 months; Month 8, 16, 20, 28, etc., excluding 
yearly visits)

Section 9.2.7 Visit 5, 8, 11, etc. (every 12 months; Month 12, 24, 36, etc.) - amended

Section 9.2.8 Up-titration Visit (unscheduled; from 4 weeks ± 7 days post-titration)

Section 9.2.9 Premature Discontinuation (PD) Visit

Section 9.2.10 End of study (EOS) visit

Section 9.2.1 Post-Treatment (PT) Visit

Section 9.3.2 Medical history

Section 9.4 Efficacy

Section 9.5 Pharmacokinetics / pharmacodynamics

Section 9.6.1.1 Definitions

Section 9.6.1.3 Assessments and documentation of adverse events (AEs)

Section 9.6.1.4 Reporting of serious adverse events (SAEs)

Section 9.7.1 Monitoring of blood potassium

Section 9.7.2.2 Local laboratory

Section 9.7.6 Electrocardiogram (ECG)

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
Section 9.7.8.1.1 Echocardiography sub-study

Section 9.7.8.1.3 Iohexol clearance sub-study

Section 10.2 Analysis sets

Section 10.3.1.1 Disposition

Section 10.3.1.3 Demography and other baseline characteristics

Section 10.3.2 Treatment duration, extent of exposure, up-titration status and 
compliance

Section 10.3.3.5.1 UACR and albuminuria

Section 10.4 Determination of sample size

Section 10.5 Planned interim analyses

Section 16.4 Definition of cardiovascular disease (CVD)
Changes to the protocol text
15.1.2
In the sections on changes to the protocol text, all protocol sections affected by the respective 
amendment are detailed; the sequence of the sections follows the structure of the most recent 
previous protocol version. As applicable, changes to the protocol text are highlighted as 
follows:
Addition of a whole new portion
Brief identification of the new portion
Removal of a whole portion
Complete display of the removed portion, formatted 
as crossed out
Editing of an existing portion
Comparative presentation of “old text” versus “new 
text”, with “old text” referring to the most recent 
previous protocol version. Deletions are crossed out
in the “old text”. Additions are underlined in the 
“new text”. 
Tables / figures
The term “amended” is added to the caption.
Terminological changes
Brief specification of the terminological change
Thus, in this section, a terminological change (e.g. 
“period” versus “epoch”) is defined only once, 
without displaying “old text” versus “new text” for 
each appearance.
Corrections of typos are not highlighted in this section.

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15.1.2.1
Section 1 Title page
Old text:
Sponsor:
Bayer HealthCare AG, D-51368 Leverkusen, Germany
Sponsor’s medical expert:
Bayer Public Limited Company
Bayer House
Strawberry Hill
RG14 1JA Newbury
United Kingdom
Phone no.: 
New text:
Sponsor:
Non-US territory: Bayer AG, D-51368 Leverkusen, Germany
US territory: Bayer Healthcare Pharmaceuticals Inc.,
100 Bayer Boulevard, P.O. Box 915, Whippany 
NJ 07981-0915, USA
Sponsor’s medical expert:
Bayer Public Limited Company
400 South Oak Way
RG2 6AD Reading
United Kingdom
Phone no.: 
15.1.2.2
Synopsis
Old text:
Test drugs
Name of active ingredient Finerenone
Doses

10 mg finerenone tablet once daily (OD) in the morning OR

20 mg finerenone tablet OD in the morning
Route of administration
Oral
Duration of treatment
Approximately 3 years (i.e. an anticipated 1.5-year recruitment period plus a 
study drug treatment period of 1.5-year after enrolment of the last patient into 
the trial)
PPD
PPD
PPD
PPD

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Reference drug
Name of active ingredient Placebo
Dose

Placebo tablet OD in the morning
Route of administration
Oral
Duration of treatment
Approximately 3 years (i.e. an anticipated 1.5-year recruitment period plus a 
study drug treatment period of 1.5-year after enrolment of the last patient into 
the trial)
New text:
Test drugs
Name of active ingredient Finerenone
Doses

10 mg finerenone tablet once daily (OD) in the morning OR

20 mg finerenone tablet OD in the morning
Route of administration
Oral
Duration of treatment
As an event-driven trial, the actual length of the treatment will depend on the 
observed event rate, the patient recruitment rate, and length of the recruitment 
period and will be between approximately 3.5 and up to 4 years 
Reference drug
Name of active ingredient Placebo
Dose

Placebo tablet OD in the morning
Route of administration
Oral
Duration of treatment
As an event-driven trial, the actual length of the treatment will depend on the 
observed event rate, the patient recruitment rate, and length of the recruitment 
period and will be between approximately 3.5 and up to 4 years
15.1.2.3
Section 5 Study design
Old text:
[…]
Patients from approximately 600 study centers worldwide will be randomized in a 1:1 ratio to 
either finerenone or placebo in addition to SoC therapy. Assuming a screening failure rate of 
approximately 50%, 12800 patients will have to be screened to randomize approximately 
6400 patients. 
The anticipated duration of the study is approximately 3 years: this includes an anticipated 
recruitment period of 1.5 years followed by a study drug treatment period of 1.5 years after 
the enrolment of the last patient into the trial.
[…]
Run-in Period (4 up to 16 weeks)
Subjects with written informed consent who complete the Run-in Visit and meet all eligibility
criteria will be enrolled into a mandatory Run-in Period, the purpose of which is to ensure that 
the subject’s SoC therapy including treatment with ACEIs or ARBs is optimized and that all 
inclusion and exclusion criteria are met at the Screening Visit. 

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[…]
Screening Period (up to 2 weeks)
At the end of the Run-in Period, a Screening Visit to confirm the subject’s eligibility will take 
place within ≤ 2 weeks prior to the planned randomization. At this visit, it will be assessed 
whether the subject still meets all the inclusion and none of the exclusion criteria.
[…]
Treatment Period
[…]
There will be up to 4 planned visits (including randomization at Visit 1) in the first 4 months; 
thereafter visits will take place every 4 months until the end of the study. Study drug dose can 
be up-titrated at scheduled visits starting from Visit 2 (Month 1) onwards or down-titrated at 
any point (even between scheduled visits); guidance on dose adjustment is provided in 
Section 7.4. Subjects may be seen at any time throughout the study, in addition to scheduled 
visits, at the discretion of the investigator.
[…]
End of study
[…]
All subjects who withdraw consent can be followed up for vital status if they do not sign the 
‘Declaration of Objection’ form. In addition, vital status can be obtained by the investigator 
from publicly available data sources. The collection of vital status must be obtained within the 
timelines provided by Bayer.
[…]
New text:
[…]
Patients from approximately 900 study centers worldwide will be randomized in a 1:1 ratio to 
either finerenone or placebo in addition to SoC therapy. Assuming a screening failure rate of 
approximately 50%, 12800 patients will have to be screened to randomize approximately 
6400 patients. 
The anticipated duration of the study is approximately 4 up to 4.5 years: this includes an 
anticipated recruitment period of approximately 2.75 to up to 3.5 years followed by a study 
drug treatment period of approximately 11 and 7 months, respectively, after the enrolment of 
the last patient into the trial and a maximum of 4.5 months for the run-in and screening period 
and 1 month for the follow-up. 
[…]

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Run-in Period (4 up to 16 weeks)
Subjects with written informed consent who complete the Run-in Visit and meet all 
eligibility3 criteria will be enrolled into a mandatory Run-in Period, the purpose of which is to 
ensure that the subject’s SoC therapy including treatment with ACEIs or ARBs is optimized 
and that all inclusion and exclusion criteria are met at the Screening Visit. 
3 Eligibility criteria related to central laboratory evaluation will be assessed once results are available.
[…]
Screening Period (up to 2 weeks)
At the end of the Run-in Period, a Screening Visit to confirm the subject’s eligibility will take 
place within ≤ 2 weeks prior to the planned randomization. At this visit, it will be assessed 
whether the subject still meets all the inclusion and none of the exclusion criteria.3
3 Eligibility criteria related to central laboratory evaluation will be assessed once results are available.
[…] 
Treatment Period
[…]
There will be up to 4 planned visits (including randomization at Visit 1) in the first 4 months; 
thereafter visits will take place every 4 months until the end of the study. Study drug dose can 
be up-titrated from Visit 2 (Month 1) onwards or down-titrated at any point (even between 
scheduled visits); guidance on dose adjustment is provided in Section 7.4. Subjects may be 
seen at any time throughout the study, in addition to scheduled visits, at the discretion of the 
investigator.
[…]
Follow-up period
All subjects who withdraw consent can be followed up for vital status if they do not sign the 
‘Declaration of Objection’ form. In addition, vital status can be obtained by the investigator 
from publicly available data sources. The collection of vital status must be obtained within the 
timelines provided by Bayer.
[…]
15.1.2.4
Figure 5-1 Overall study design
Old text:
‡
For all subjects who received SD. Subjects who continued taking study drug until the 
EOS visit and consent to the LTE study will not have to undergo this visit.
New text:
‡
For all subjects still on treatment with SD at the EoS Visit

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15.1.2.5
Section 6.2 Exclusion criteria 
Old text:
2. UACR > 5000 mg/g (> 565 mg/mmol) at the Run-in Visit or Screening Visit
[…]
5. SBP < 90 mmHg at the Run-in Visit or at the Screening Visit
[…]
7. Stroke, transient ischemic cerebral attack, acute coronary syndrome, or hospitalization for 
worsening heart failure, in the last 30 days prior to the Run-in Visit
[…]
18. Previous assignment to treatment during this study or Studies 16244 or 16275
New text:
2. UACR > 5000 mg/g (> 565 mg/mmol) at the Run-in Visit or Screening Visit
Note: One re-assessment is allowed in case UACR is > 5000 mg/g in one of the three 
urine samples collected at the Run-in Visit and the Screening Visit.
[…]
5. Mean SBP < 90 mmHg at the Run-in Visit or at the Screening Visit
[…]
7. Stroke, transient ischemic cerebral attack, acute coronary syndrome, or hospitalization for 
worsening heart failure, in the last 30 days prior to the Screening Visit
[…]
18. Previous assignment to treatment during this study or Study 16244
15.1.2.6
Section 6.4.1.1 Discontinuation of study drug
Old text:

The randomization code is broken for any reason
[…]
If a subject no longer on study drug is unable to attend the clinic for a study visit, a telephone 
consultation may be performed to determine if relevant health events / endpoints (e.g. 
development of CV or renal complications) have occurred. Ideally, a face-to-face visit should 
be performed at least once a year.
New text:

The randomization code is broken by the investigator, or other responsible person, 
when knowledge of the subject’s treatment is required

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[…]
If a subject no longer on study drug is unable to attend the clinic for a study visit, a 
telephone consultation may be performed to determine if relevant health events / endpoints 
(e.g. development of CV or renal complications) have occurred. Ideally, a face-to-face visit 
should be performed at least once a year. Expected frequency of telephone contacts should be 
in line with the standard visit schedule, and therefore performed every 4 months. Ad hoc 
additional telephone contacts may also be requested (e.g. prior to the interim analysis) and 
made to the subject themselves, a next of kin or primary physician (or local equivalent).
15.1.2.7
Section 6.4.2.1 Re-screening
Old text:
If a subject is not eligible at the Run-in or Screening Visit for either this study (17530) or 
Study 16244, the subject may be re-screened at a later time provided the investigator believes that 
a change in the subject’s condition will make the subject potentially eligible at a later time point.
[…]

A minimum of 6 months between the initial Run-in Visit and re-screening.
Re-screening of the subject is not allowed if elevated blood potassium was the reason for the 
subject’s non eligibility.
A subject may be re-screened only once. During re-screening, a switch over between studies 
is allowed (see Section 6.4.2.2).
New text:
If a subject is not eligible at the Run-in or Screening Visit for either this study (17530) or 
Study 16244, the subject may be re-screened at a later time. 
[…]

A minimum of 3 months between the initial Run-in Visit and re-screening.
A subject may be re-screened only once and after being declared as a screening failure.  
During re-screening, a switch over between studies is allowed (see Section 6.4.2.2).
15.1.2.8
Section 7.3 Treatment assignment
Old text:
Eligible subjects will be randomized within ≤2 weeks after the Screening Visit. The 
randomization will be stratified by region (North America, Europe, Asia, Latin America and 
others), type of albuminuria at screening (high or very high albuminuria) and eGFR at 
screening (25 to <45, 45 to <60, ≥60 mL/min/1.73m²) and history of CVD (present, absent). 
The eGFR will be calculated by the Central Laboratory applying the CKD-EPI formula (36).

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New text:
Eligible subjects will be randomized within ≤2 weeks after the Screening Visit. The 
randomization will be stratified by region (North America, Europe, Asia, Latin America and 
others), type of albuminuria at screening (high or very high albuminuria) and eGFR at 
screening (25 to <45, 45 to <60, ≥60 mL/min/1.73m²) and history of CVD (present, absent; 
see definition of CVD in Table 16–5). The eGFR will be calculated by the Central Laboratory 
applying the CKD-EPI formula (36).
15.1.2.9
Section 7.4 Dosage and administration
Old text:
Up- and down-titration of study drug
If a subject started with the lower dose of finerenone, the investigator may up-titrate the dose 
of study drug. Up-titration can be performed at any scheduled visit from Visit 2 (Month 1) 
onwards provided:
[…]
Subjects who started with or were up-titrated to the target dose (20 mg OD) of the study drug 
but who do not tolerate this dose may be down-titrated at any point during the study, 
including between-scheduled visits if required for safety reasons. These subjects may be 
up-titrated at any scheduled visit based on the rules provided above. […]
Subsequent to any up-titration or re-start of study drug after interruption of study drug intake, 
the investigator should perform an unscheduled visit within 4 weeks (±7 days) of titration or 
restart, in order to monitor potassium levels and renal function. […]
All titrations, including the reasons for down-titration, must be documented in the eCRF.
New text:
Up- and down-titration of study drug
The investigator is encouraged to up-titrate the dose of study drug at any time once the patient 
has been on a stable dose for 4 weeks (± 7 days) (e.g. from Visit 2 onwards for patient starting 
study drug on the lower dose) either at a regular visit or an Up-titration Visit. Up-titration can 
be performed provided:
[…]
Subjects who started with or were up-titrated to the target dose (20 mg OD) of the study drug 
but who do not tolerate this dose may be down-titrated at any point during the study, 
including between-scheduled visits if required for safety reasons. These subjects may be 
up-titrated again based on the rules provided above. […]
Subsequent to an up-titration or re-start of study drug after interruption of study drug intake
for more than 7 days, the investigator should perform an Up-titration Visit 4 weeks (±7 days) 
after titration or restart, in order to monitor potassium levels and renal function (see Table 9-

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1). If a regular study visit will be scheduled to take place 4 weeks (± 7 days) after up-titration, 
the monitoring of potassium and renal function is assured and no Up-titration Visit has to be 
performed in addition. […]
All titrations, including the reasons for down-titration or for not dispensing the 20 mg dose, 
must be documented in the eCRF.
15.1.2.10
Section 7.5.2 Unblinding
Old text:
In compliance with applicable regulations, in the event of a SUSAR (see Section 9.6.1.4) 
related to the blinded treatment, the subject’s treatment code will usually be unblinded before 
reporting to the health authorities, ethic committees and investigators.
New text:
In compliance with applicable regulations, in the event of a SUSAR (see Section 9.6.1.4) 
related to the blinded treatment, the subject’s treatment code will usually be unblinded before 
reporting to the health authorities and ethic committees.
15.1.2.11
Section 8.1.3 Control of blood pressure
Old text:
According to international guidelines, the target blood pressure for subjects with T2DM is 
<140/90 mmHg (39, 40). […]
New text:
According to international guidelines, the recommended target blood pressure for subjects 
with T2DM and albuminuria, who are at increased risk of CVD and CKD progression, is 
<130/80 mmHg (39-41). […]

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15.1.2.12
Table 9-1 Study 17530: schedule of activities and evaluations
Old text: 
Table 9-1
Study 17530: schedule of activities and evaluations
Visit 
Run-in
Screening
Visit
1 
Visit 
2
Visit 
3
Visit
4, 6, 7, 
9, etc h
Visit
5, 8, 11, 
etc
Up-titration 
visit j
PD
visit
EOS
visit k
PT
visit m
(Baseline)
(every 
4 months)
(every 
12 months)
(from 4 weeks 
± 7 days 
post-titration)
        Day / Month
4 to 16 weeks 
pre-screening
2 weeks
Day
1
Month
1
Month
4
Month
8, 16, 
20, 28, etc
Month
12, 24, 
36, etc
Unscheduled
After SD is 
permanently 
discontinued
After
study 
termination
4 weeks 
+ 5 days 
after last 
SD intake 
[…]
NOTE: 
One month corresponds to 30 days
A time frame of ± 7 days is allowed for Visit 2 (Month 1), and for the unscheduled Up-titration Visit(s).
A time frame of ± 12 days is allowed for all regular visits from Visit 3 (Month 4) onwards.
[…]
c
First morning void urine samples to be collected at the subject’s home on 2 consecutive days before scheduled visit and on the day of the visit. At the 
Run in visit, the 3 samples can be collected the 3 days after the visit.
d
Blood samples (for potassium and creatinine) for measurement in the local laboratory.  Samples to be taken only if the subject is still taking study drug.
[…]
f
AEs related to study procedures occurring after signing the informed consent as well as all other AEs starting after the first dose of study drug will be 
documented on the respective eCRF pages.
[…]
j
These procedures also apply for a re-start of study drug after interruption of study drug intake .
m
For all the subjects who have taken any study drug, the PT Visit has to be performed 4 weeks + 5 days after last intake of study drug. 
n
A trough PK sample will be drawn before study drug is administered at the study center by study personnel. The exact time of study drug intake on the 
day before the visit and on the day of the visit and the exact sampling time will have to be recorded in the eCRF.
o
Study drug will be taken as usual in the morning at home. One PK sample will be drawn during the visit. The exact time of study drug intake and the 
exact sampling times will have to be recorded in the eCRF.

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New text:
Table 9-1
Study 17530: schedule of activities and evaluations
Visit 
Run-in
Screening
Visit 
1 
(Baseline)
Visit 
2
Visit 
3
Visit
4, 6, 7, 9,
etc h
Visit
5, 8, 11, 
etc
Up-titration 
Visit j
PD
Visit
EOS
Visit k
PT
Visit m
Day / Month
4 to 16 
weeks pre-
screening
2 weeks
Day
1
Month
1
Month
4
(every 
4 months, 
i.e. Month 8, 
16, 20, 28, etc)
(every 
12 months, 
i.e. Month 
12, 24, 
36, etc)
For up-titration/restart 
after interruption, 
and for safety check 
4 weeks ± 7 days after 
any up-titration (see 
also footnote j)
As soon as 
possible but 
within 7 days 
after SD is 
permanently 
discontinued
After
study 
termi-
nation
4 weeks 
+ 5 days 
after last 
SD intake 
[…]
NOTE: 
One month corresponds to 30 days
A time frame of ± 7 days is allowed for Visit 2 (Month 1), and for the Up-titration Visit(s).
A time frame of ± 12 days is allowed for all regular visits from Visit 3 (Month 4) onwards.
[…]
c
At Visit 1, first morning void urine samples to be preferably collected on three consecutive days at the subject’s home within 7 days before scheduled 
visit and before any intake of study drug. At the other visits the 3 consecutive samples can be collected ± 7 days from the visit date.
d
Blood samples (for potassium and creatinine) for measurement in the local laboratory may be obtained up to 72 hours before a scheduled visit.
Samples to be taken only if the subject is still taking study drug.
[…]
f
AEs related to study procedures occurring after signing the informed consent as well as all other AEs starting after randomization will be documented on 
the respective eCRF pages.
[…]
j
The “Up-titration Visit” should be performed for up-titration (at any time after Visit 2), after restart of SD after an interruption for >7 days, and for safety 
check 4 weeks ± 7days after any up-titration.
m
For all the subjects still on treatment with study drug at the EOS Visit, the PT Visit has to be performed 4 weeks + 5 days after last intake of study drug.
n
A trough PK sample will be drawn before study drug is administered at the study center by study personnel. The exact time of study drug intake on the 
day before the visit and on the day of the visit and the exact sampling time will have to be recorded in the eCRF. If the trough sample was not taken 
at Visit 3 it should be obtained at Visit 4 (see Section 9.5).
o
Study drug will be taken as usual, ideally in the morning at home. One PK sample will be drawn during the visit. The exact time of study drug intake and 
the exact sampling times will have to be recorded in the eCRF.

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15.1.2.13
Table 9-2 Sub-studies of Study 17530: schedule of procedures
Old text: 
Table 9-2
Sub-studies of Study 17530: schedule of procedures
Visit 
Run-in
Screening
Visit
1 
Visit 
2
Visit 
3
Visit
4, 6, 7, 
9, etc
Visit
5, 8, 11, etc
Up-titration 
visit
PD
visit
EOS
visit
PT
visit c
(Baseline)
(every 
4 months)
(every 
12 months)
(from 4 weeks 
± 7 days 
post-titration)
         Day / Month
4 to 16 weeks 
pre-screening
2 weeks
Day
1
Month
1
Month
4
Month
8, 16, 
20, 28 etc
Month
12, 24, 36 etc
Unscheduled
After SD is 
permanently 
discontinued
After
study
termination
4 weeks 
+ 5 days 
after last 
SD intake 
Informed consent a
X
Echocardiography
X
X
X e
X e
Sampling for biomarkers
X
X
X
X e
X e
Iohexol clearance b
X
X
X d
X e
X e
X
[…]
c
For all the subjects who have taken any study drug, the PT Visit has to be performed 4 weeks + 5 days after last intake of study drug. 
d
Every other visit (i.e. every 8 months)
[…]

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New text: 
Table 9-2
Sub-studies of Study 17530: schedule of procedures
Visit 
Run-in
Screening
Visit 
1 
(Baseline)
Visit 
2
Visit 
3
Visit
4, 6, 7, 9,
etc h
Visit
5, 8, 11, 
etc
Up-titration 
visit
PD
visit
EOS
visit
PT
visit c
Day / Month
4 to 16 weeks 
pre-
screening
2 weeks
Day
1
Month
1
Month
4
(every 
4 months, 
i.e. Month 8, 
16, 20, 28, 
etc)
(every 
12 month
s, i.e. 
Month 12, 
24, 36, etc)
For up-
titration/restart 
after 
interruption, 
and for safety 
check 4 weeks 
± 7 days after 
any up-titration
As soon as 
possible but 
within 7 days 
after SD is 
permanently 
discontinued
After
study termi-
nation
4 weeks + 5 
days after 
last 
SD intake 
Informed consent a
X
Echocardiography f
X
X
X e
X e
Sampling for biomarkers
X
X
X
X e
X e
Iohexol clearance b
X
X
X d
X d
X e
X e
X
[…]
c
For all the subjects still on treatment with study drug at the EOS Visit, the PT Visit has to be performed 4 weeks + 5 days after last intake of study drug. 
d
Every other visit (every 8 months), i.e. Visit 5, Visit 7, Visit 9, Visit 11, etc.
[…]
f   Time window for the assessment at Visit 1 is -14/+7 days, at other visits ± 30 days. Each time an echocardiography is performed, one blood sample should 
be drawn to assess the echo biomarkers.

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15.1.2.14
Section 9.2 Visit description
Old text:
One month in the study schedule corresponds to 30 days. Although study visits should occur 
as close as possible to the time points specified in the protocol, a time frame of ± 7 days is 
allowed for Visit 2 (Month 1), and for the unscheduled Up-titration Visit(s).  Starting from 
Visit 3 (Month 4), a time frame of ± 12 days is allowed for all regular visits.
[…]
New text:
One month in the study schedule corresponds to 30 days. Although study visits should occur 
as close as possible to the time points specified in the protocol, a time frame of ± 7 days is 
allowed for Visit 2 (Month 1), and for the Up-titration Visit(s).  Starting from Visit 3 (Month 
4), a time frame of ± 12 days is allowed for all regular visits.
All procedures and assessments should preferably be conducted on the day of the visit; 
however, if this is not possible for logistical reasons, the following time windows are allowed:
Blood sampling, ECG and recording of vital signs:

Screening Visit and all visits starting from Visit 2: Visit date ± 7 days

Run-In, PD and EOS Visit: Visit date ± 3 days
Sub-studies / iohexol and biomarker samples:

all visits starting from Visit 3: Visit date ± 7 days

PD and EOS Visit: Visit date ± 3 days
Sub-study / echocardiography (note that each time an echocardiography is performed, one 
blood sample should be drawn to assess the echo biomarkers):

at Visit 1: Visit date -14 / +7 days

Other visits: Visit date ± 30 days
[…]
15.1.2.15
Section 9.2.1 Run-in Visit (4 to 16 weeks prior to the Screening Visit)
Old text:

Take samples (hematology, HbA1c, chemistry and urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1).
New text:

Take samples (hematology, HbA1c, chemistry, urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1)
Note: If HbA1c cannot be analysed by the central laboratory due to technical reasons, 

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subject can be considered suitable for randomization with one result only (Run-In or 
Screening).
15.1.2.16
Section 9.2.2 Screening Visit (≤2 weeks prior to Visit 1)
Old text:

Take samples (hematology, HbA1c, chemistry and urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1).
New text:

Take samples (hematology, HbA1c, chemistry, urinalysis) for central laboratory 
evaluations (see Section 9.7.2.1)
Note: If HbA1c cannot be analysed by the central laboratory due to technical reasons, 
subject can be considered suitable for randomization with one result only (Run-In or 
Screening).
15.1.2.17
Section 9.2.3 Visit 1 (randomization; Day 1 and baseline)
Old text:
All measurements on Visit 1 are to be performed before first study drug intake. The following 
procedures and assessments will be performed at Visit 1:
[…]

Optional: if the subject had signed informed consent for the sub-study, obtain 
respective samples for biomarkers (see Section 9.7.8.1.2) and/or iohexol clearance 
(see Section 9.7.8.1.3), perform echocardiography (see Section 9.7.8.1.1)
New text:
All measurements on Visit 1 are to be performed on the day of the visit before first study drug 
intake. The following procedures and assessments will be performed at Visit 1:
[…]

Optional: if the subject had signed informed consent for the sub-study, obtain 
respective samples for biomarkers (see Section 9.7.8.1.2) and/or iohexol clearance 
(see Section 9.7.8.1.3), perform echocardiography (see Section 9.7.8.1.1)
Note: Time window for the echocardiography at Visit 1 is -14/+7 days. On the day the 
echocardiography is performed, a blood sample should also be drawn to assess the 
echo biomarkers.

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15.1.2.18
Section 9.2.5 Visit 3 (Month 4)
Old text:

Obtain sample for PK (see Section 9.5)
New text:

Obtain pre-dose sample for PK (see Section 9.5)
15.1.2.19
Section 9.2.6 Visit 4, 6, 7, 9, etc. (every 4 months; Month 8, 16, 20, 28,
etc., excluding yearly visits)
Old text:

Take samples (potassium, creatinine) for local safety laboratory evaluations (see 
Section 9.7.2.2) 

Optional: if the subject had signed informed consent for the sub-study, obtain samples 
for iohexol clearance (see Section 9.7.8.1.3). 
Note: Iohexol clearance should be performed every 8 months only
New text:

Take samples (potassium, creatinine) for local safety laboratory evaluations (see 
Section 9.7.2.2) 

Visit 4 only: Obtain pre-dose sample for PK if no PK sample was taken at Visit 3 (see 
Section 9.5)

Optional: if the subject had signed informed consent for the sub-study, obtain samples 
for iohexol clearance (see Section 9.7.8.1.3). 
Note: Iohexol clearance should be performed every 8 months only (Visit 7, Visit 9, 
etc.)
15.1.2.20
Section 9.2.7 Visit 5, 8, 11, etc. (every 12 months; Month 12, 24, 36, 
etc.) - amended
Added text:

Optional: if the subject had signed informed consent for the sub-study, obtain samples 
for iohexol clearance (see Section 9.7.8.1.3).
Note: Iohexol clearance should be performed every 8 months only  (Visit 5, Visit 11, 
etc.)

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15.1.2.21
Section 9.2.8 Up-titration Visit (unscheduled; from 4 weeks ± 7 days
post-titration)
Old text:
9.2.8 Up-titration Visit (unscheduled; from 4 weeks ± 7 days post-titration)
The following procedures and assessments will be performed at the Up-titration Visit. These 
procedures also apply for a re-start of study drug after interruption of study drug intake.

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance 
(see Section 7.6)
New text:
9.2.8 Up-titration Visit (4 weeks ± 7 days after up-titration or restart of study drug, and 
for up-titration of study drug)
The following procedures and assessments will be performed at the Up-titration Visit (see 
Section 7.4 for details). 

Record use of concomitant medication (see Section 8.1)

Collect unused study drug and perform accountability to assess compliance, if 
applicable (see Section 7.6)
15.1.2.22
Section 9.2.9 Premature Discontinuation (PD) Visit
Old text:
9.2.9
Premature Discontinuation (PD) Visit
The following procedures and assessments will be performed at the PD Visit:
New text:
9.2.9
Premature Discontinuation (PD) Visit (as soon as possible but within 7 days after
study drug is permanently discontinued)
If the PD visit cannot be performed within the timeframe specified, no PD visit is required.
The following procedures and assessments will be performed at the PD Visit:
15.1.2.23
Section 9.2.10 End of study (EOS) visit
Added text:

In exceptional circumstances only, if the subject is unable to attend this visit during 
the given timeframe, the subject (or primary physician / next of kin) should be 
contacted to obtain survival status. 

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15.1.2.24
Section 9.2.1 Post-Treatment (PT) Visit
Old text:
The following procedures and assessments will be performed at the PT Visit:
New text:
For all subjects who are still on treatment with study drug at the end of study visit, the 
following procedures and assessments will be performed at the PT Visit:
15.1.2.25
Section 9.3.2 Medical history
Old text:

Start before first dose of study drug
New text:

Start before randomization 
15.1.2.26
Section 9.4 Efficacy
Old text:
Definitions of individual endpoints (e.g. CV death) will be provided in the Endpoint Manual. 
New text:
Kidney failure is defined as either the occurrence of ESRD or an eGFR of less than 15 
mL/min/1.73 m², confirmed by a second measurement at the earliest 4 weeks after the initial 
measurement.  ESRD is defined as the initiation of chronic dialysis (haemo- or peritoneal-
dialysis) for at least 90 days or renal transplantation. In addition, the eGFR threshold of 15 
mL/min/1.73 m² is consistent with the definition of kidney failure from KDIGO (Kidney 
Disease: Improving Global Outcomes)(3) and was chosen in order to include an objective 
component to the endpoint because the decision to initiate dialysis therapy or kidney 
transplantation may be affected by factors other than the eGFR. All other definitions of 
individual endpoints (e.g. CV death) will be provided in the Endpoint Manual. 
15.1.2.27
Section 9.5 Pharmacokinetics / pharmacodynamics
Old text:
At Visit 3 (Month 4), a trough sample for the determination of finerenone plasma 
concentrations will be drawn before intake of study drug. [...]
The PK bioanalysis will be performed under the responsibility of Bayer HealthCare
Bioanalytics Laboratory, Bayer Pharma AG, GDD-GED-DMPK Bioanalytics, 42096 
Wuppertal, Germany.

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New text:
At Visit 3 (Month 4), a trough sample for the determination of finerenone plasma 
concentrations will be drawn before intake of study drug (if the sample could not be obtained 
at Visit 3, it can be drawn at Visit 4). [...]
PK sampling is not necessary if the study treatment was temporarily interrupted or 
permanently discontinued at the time of the visit.
The PK bioanalysis will be performed under the responsibility of Bayer Bioanalytics 
Laboratory, Bayer AG,
 42096 Wuppertal, Germany. Study 
responsible bioanalytical personnel will remain unblinded during the study.  
15.1.2.28
Section 9.6.1.1 Definitions
Old text:
All diagnoses, symptom(s), sign(s) or finding(s) with a start date after first dose of study drug
must be recorded as (S)AEs, except those related to study procedure. [...]
A surgical procedure that was planned prior to administration of study drug by any physician 
treating the subject should not be recorded as an AE (however, the condition for which the 
surgery is required may be an AE).
[...]

Conditions that were present before first dose of study drug and for which no 
symptoms or treatment are present until administration of study drug are recorded as 
medical history (e.g. seasonal allergy without acute complaints)

Conditions that started before first dose of study drug and for which symptoms or 
treatment are present after first dose of study drug, at unchanged intensity, are recorded as 
medical history (e.g. allergic pollinosis)

Conditions that started or deteriorated after first dose of study drug will be 
documented as (S)Aes
New text:
All diagnoses, symptom(s), sign(s) or finding(s) with a start date from randomization 
onwards must be recorded as (S)AEs, except those related to study procedure. [...]
A surgical procedure that was planned prior to randomization by any physician treating the 
subject should not be recorded as an AE (however, the condition for which the surgery is 
required may be an AE).
[...]

Conditions that were present before randomization and for which no symptoms or 
treatment are present until randomization are recorded as medical history (e.g. 
seasonal allergy without acute complaints)
PPD

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
Conditions that started before randomization and for which symptoms or treatment are 
present after randomization, at unchanged intensity, are recorded as medical history (e.g. 
allergic pollinosis)

Conditions that started or deteriorated after randomization will be documented as 
(S)AEs
15.1.2.29
Section 9.6.1.3 Assessments and documentation of adverse events
(AEs)
Old text:
AEs observed, mentioned upon open questioning by a member of the investigator’s team or 
spontaneously reported by the patient will be documented. The observation period for AEs 
will start with administration of first dose of study drug and will end with the last visit of 
follow-up except for AEs related to study procedures; the observation period for the latter 
AEs will start with signed informed consent and will end with the last visit of follow-up. 
New text:
AEs observed, mentioned upon open questioning by a member of the investigator’s team or 
spontaneously reported by the patient will be documented. The observation period for AEs 
will start with randomization and will end with the last visit of follow-up except for 
AEs related to study procedures; the observation period for the latter AEs will start with 
signed informed consent and will end with the last visit of follow-up.
15.1.2.30
Section 9.6.1.4 Reporting of serious adverse events (SAEs)
Old text:
In compliance with applicable regulations, in the event of a SUSAR, the subject’s treatment 
code will usually be unblinded before reporting to the competent authorities, IECs/IRBs. For 
reporting to investigators the treatment blind, if possible, will be kept.
New text:
In compliance with applicable regulations, in the event of a SUSAR, the subject’s treatment 
code will usually be unblinded before reporting to the competent authorities, IECs/IRBs. For 
reporting to investigators the treatment blind will be kept.
15.1.2.31
Section 9.7.1 Monitoring of blood potassium
Old text:

Blood potassium should be measured within the first month (4 weeks ± 7 days) after 
re-starting treatment or dose adjustment, especially after up-titration

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New text:

Blood potassium should be measured 4 weeks (± 7 days) after re-starting treatment or 
dose adjustment, especially after up-titration
15.1.2.32
Section 9.7.2.2 Local laboratory
Old text:
In addition to samples for the central laboratory, other blood safety samples will be taken 
from Visit 1 (Day 1; baseline) onwards (see Table 9-1) for analysis at the local laboratory.  
These samples will be taken only while the subject is treated with the study drug.
The following clinical chemistry parameters must be measured for as long as subject is treated 
with the study drug:

Blood potassium

Serum creatinine (eGFR will be calculated automatically in the eCRF using the 
CKD-EPI formula (36)).
[…]
In women of childbearing potential, a pregnancy test will be performed locally, at the 
Screening Visit and following randomization at yearly visits. [...]
New text:
In addition to samples for the central laboratory, other blood safety samples will be taken 
from Visit 1 (Day 1; baseline) onwards (see Table 9-1) for analysis at the local laboratory.  
These samples may be obtained up to 72 hours before a scheduled visit.
The following clinical chemistry parameters must be measured for as long as subject is not 
prematurely discontinued from the study drug:

Blood potassium

Blood creatinine (eGFR will be calculated automatically in the eCRF using the 
CKD-EPI formula (36)).
[…]
In women of childbearing potential, a pregnancy test will be performed locally, at the 
Screening Visit and following randomization at yearly visits as long as the subject is not 
permanently discontinued from the study drug (since more than 7 days). [...]

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15.1.2.33
Section 9.7.6 Electrocardiogram (ECG)
Old text:
A standard 12-lead ECG will be performed locally at the Run-In Visit, Screening Visit, at 
Visit 1 (Day 1; baseline), at the yearly visits, and again at the PD, EOS and PT Visits (see 
Table 9-1).
New text:
A standard 12-lead ECG will be performed locally at the Run-In Visit, Screening Visit, at 
Visit 1 (Day 1; baseline), at the yearly visits, and again at the PD, EOS and PT Visits (see 
Table 9-1). If there is any clinical indication, unscheduled 12-lead ECGs can be performed at 
any point during the study.
15.1.2.34
Section 9.7.8.1.1 Echocardiography sub-study
Old text:
In all participating sites, echocardiography will be performed according to a study-specific 
protocol at Visit 1 (Day 1; baseline), at yearly visits and at the end of the study (either at the 
PD Visit or the EOS Visit). 
Echocardiography examinations, data collection and procedures for central blinded adjudication 
in the echo core laboratory are given in the Echocardiography Manual. Vital signs (i.e. systolic 
and diastolic BP and heart rate) should be measured during echocardiography in addition to 
acquisition of echo data. In addition, each time an echocardiography is performed, one blood 
sample should be drawn to assess the following biomarkers shown in Table 9-5.
[...] Quantitative measures on all study echocardiographies will be performed by dedicated 
analysts at the core laboratory, who will be blinded to clinical information and randomized
treatment assignment. 
New text:
In all participating sites, echocardiography will be performed according to a study-specific 
protocol at Visit 1 (Day 1; baseline), at yearly visits and at the end of the study (either at the 
PD Visit or the EOS Visit). If a baseline assessment is not available or analysable, the subject 
will not continue to undergo echocardiography assessments due to the inability to perform a 
comparison against baseline.
Echocardiography examinations, data collection and procedures for central blinded adjudication 
in the echo core laboratory are given in the Echocardiography Manual. In addition, each time an 
echocardiography is performed, one blood sample should be drawn to assess the following 
biomarkers shown in Table 9-5.

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[...] Quantitative measures on all study echocardiographies will be performed by dedicated 
analysts at the core laboratory, who will be blinded to clinical information and randomized 
treatment assignment. The echocardiography results will not be provided to sites. 
15.1.2.35
Section 9.7.8.1.3 Iohexol clearance sub-study
Old text:
Iohexol plasma clearance will be assessed at Visit 1 (Day 1, baseline), at Visit 3 (Month 4) 
and thereafter at every other visit (i.e. every 8 months) until the end of the study (either at the 
PD Visit or the EOS Visit) plus an additional assessment at the PT Visit (recovery). 
New text:
Iohexol plasma clearance will be assessed at Visit 1 (Day 1, baseline), at Visit 3 (Month 4) 
and thereafter at every other visit (i.e. every 8 months) until the end of the study (either at the 
PD Visit or the EOS Visit) plus an additional assessment at the PT Visit (recovery). The 
Iohexol results will not be provided to the sites.  
15.1.2.36
Section 10.2 Analysis sets
Old text:
Per-protocol analysis set (PPS): All subjects of the FAS without major protocol deviations
[…]
All subjects will be analyzed according to the planned treatment in FAS (the intent-to-treat or 
ITT principle). All subjects will be analyzed according to the actual treatment in SAF and PPS.
New text:
Per-protocol analysis set (PPS): All subjects of the FAS without any validity findings
[…]
All subjects will be analyzed according to the planned treatment in FAS (the intent-to-treat or 
ITT principle). All subjects will be analyzed according to the actual treatment in SAF and PPS.  
If a subject receives both treatments due to a bottle error, the treatment actually received for 
the majority of the time in the study will be used in SAF and PPS.
15.1.2.37
Section 10.3.1.1 Disposition
Old text:
[...] In addition, the number of subjects with major and minor protocol deviations will be 
presented overall, by investigator and country for each treatment group, and in total. The 
frequencies of each major protocol deviation will be presented by treatment group and in total.

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New text:
[...] In addition, the number of subjects with important deviations and validity findings will be 
presented overall, by investigator and country for each treatment group, and in total. The 
frequencies of each important deviation and validity finding will be presented by treatment 
group and in total.
15.1.2.38
Section 10.3.1.3 Demography and other baseline characteristics
Old text:
[...] Other baseline characteristics include baseline UACR, serum potassium, categories for 
serum potassium (<4.5 mmol and ≥4.5 mmol), eGFR (calculated by CKD-EPI formula), 
serum creatinine, HbA1c, values for vital signs parameters (i.e. systolic blood pressure, 
diastolic blood pressure and heart rate).
New text:
[...] Other baseline characteristics include baseline UACR, serum potassium, categories for 
serum potassium (≤4.5 mmol and > 4.5 mmol), eGFR (calculated by CKD-EPI formula), 
serum creatinine, HbA1c, values for vital signs parameters (i.e. systolic blood pressure, 
diastolic blood pressure and heart rate).
15.1.2.39
Section 10.3.2 Treatment duration, extent of exposure, up-titration 
status and compliance
Old text:
Treatment duration (number of months with study drug intake, excluding any gaps) will be 
summarized using descriptive statistics by treatment group and overall. [...]
New text:
Treatment duration (number of months with study drug intake) will be summarized using 
descriptive statistics by treatment group and overall. [...]
15.1.2.40
Section 10.3.3.5.1 UACR and albuminuria
Old text:
[...] The albuminuria category changes will only be considered as shifts, if they are 
accompanied by a UACR change of more than 30% from baseline to each visit.
New text:
[...] The albuminuria category changes will only be considered as shifts, if they are 
accompanied by a UACR change of at least 30% from baseline to each visit.

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15.1.2.41
Section 10.4 Determination of sample size
Old text:
This is an event-driven study. A total of 960 primary efficacy endpoint events will have 
90% power to demonstrate superiority of finerenone to placebo using a logrank test at a 
two-sided significance level of 5.0%, assuming a 20% relative risk reduction, i.e. a true hazard 
ratio of 0.80 (the hazard ratio that will be observed in the study will be different, i.e. closer to 1 
due to treatment discontinuations). The study will stop when approximately 960 primary 
efficacy endpoints accrue across both treatment arms.
With an assumed study duration of 36 months (duration of recruitment period: 18 months, 
equal recruitment pattern during the accrual period, maximum treatment period of the last 
subject recruited: 18 months), the planned total number of subjects to be randomized is 
estimated to be 6210 subjects, assuming an annual placebo event rate of 8%, a common 
annual lost to follow-up rate of 0.7% in both treatment groups, an annual finerenone 
discontinuation rate of 5% and assuming that placebo discontinuation will not change the 
hazard. [...]
New text:
This is an event-driven study. A total of between 970 and 976 primary efficacy endpoint events 
will have 90% power to demonstrate superiority of finerenone to placebo using a logrank test at 
a two-sided significance level of 5.0%, assuming a 20% relative risk reduction, i.e. a true hazard 
ratio of 0.80 (the hazard ratio that will be observed in the study will be different, i.e. closer to 1 
due to treatment discontinuations). The study will stop when approximately 976 primary 
efficacy endpoints accrue across both treatment arms.
With an assumed treatment duration of between 44 and 48 months (duration of recruitment 
period: 33 and 41 months, equal recruitment pattern during the accrual period, maximum 
treatment period of the last subject recruited: 11 and 7 months, respectively), the planned total 
number of subjects to be randomized is estimated to be between 6212 and 6286 subjects, 
respectively, assuming an annual placebo event rate of 8%, a common annual lost-to-follow-
up rate of 0.7% in both treatment groups, an annual finerenone discontinuation rate of 5% and 
assuming that placebo discontinuation will not change the hazard. [...]
15.1.2.42
Section 10.5 Planned interim analyses
Old text:
One formal interim analysis is planned when 2/3 (640) of the required total number of 
primary efficacy endpoint events have been observed. Based on the assumptions from sample 
size determination the interim analysis will take place about 27 months after study initiation.
New text:
One formal interim analysis is planned when 2/3 of the required total number of primary 
efficacy endpoint events have been observed. Based on the assumptions from sample size 
determination the interim analysis will take place between 34 and 38 months after start of 

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study treatment. As an event-driven trial, the actual timing of the interim analysis will depend 
on the observed event rate, the patient recruitment rate, and length of the recruitment period.
15.1.2.43
Section 16.4 Definition of cardiovascular disease (CVD)
Added text:
The definition of cardiovascular disease for stratification purposes in the study is presented in 
Table 16-5. If any of these conditions below is fulfilled at Screening Visit, subject should be 
stratified as having history of cardiovascular disease in the study.
Table 16-5
Definition of cardiovascular disease for stratification purposes
Coronary Artery Disease:

Previous Myocardial Infarction (MI) 

History of coronary revascularization (percutaneous coronary intervention or coronary artery bypass 
graft)

Angiographically proven stenosis ≥ 50% in at least one major epicardial coronary artery
Cerebrovascular Disease:

Previous ischemic stroke [transient ischemic attack (TIA) alone not sufficient to fulfill this criterion]
Peripheral Arterial Disease:

Previous non-traumatic leg amputation

History of lower-limb revascularization (either surgical or percutaneous)

History of intermittent claudication with ankle brachial pressure index (ABPI) of ≤ 0.80 in at least one side

Previous carotid endarterectomy or carotid stenting
15.2
Amendment 4
Amendment 4 is presented using a different approach compared with the previous amendment 
to this protocol (Amendment 3, Section 15.1). The rationale for this amendment and all 
affected sections are provided in the “Protocol amendment summary of changes table” 
directly before the “Table of contents” in this document. Changes are made directly in the 
protocol body without annotations. A separate file with tracked changes against the last 
integrated protocol version is available upon request.

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16.
Appendices
16.1
Guidance on use of common CYP inhibitors or inducers
Table 16–1 lists the most common medication regarded as potent CYP3A4 inhibitors or 
inducers.
Table 16–1
Cytochrome P450: list of concomitant medication
Excluded
Excluded
Allowed
CYP3A4 inducers
CYP3A4 inhibitors
CYP3A4 inhibitors
▪
avasimibe
▪
amprenavir
▪
amiodarone
▪
bosentan
▪
atazanavir and other inhibitors of 
human HIV protease
▪
aprepitant
▪
carbamazepin
▪
boceprevir
▪
bicalutamide
▪
efavirenz
▪
clarithromycin
▪
chloramphenicol
▪
enzalutamide
▪
cobicistat
▪
conivaptan ≤ 20 mg
▪
etravirine
▪
conivaptan > 20 mg
▪
fluconazole ≤ 200 mg
▪
fosphenytoin
▪
crizotinib
▪
imatinib
▪
hypericum perforatum / 
St John's wort
▪
danoprevir
▪
mifepristone
▪
lersivirine
▪
darunavir
▪
norfloxacine
▪
mephenytoin
▪
delavirdine
▪
tacrolimus
▪
methylphenobarbital
▪
diltiazem
▪
verapamil
▪
mitotane
▪
dronedarone
▪
lapatinib
▪
modafinil
▪
elvitegravir
▪
dasatinib
▪
nafcillin
▪
erythromycin
▪
nilotinib
▪
nevirapine
▪
fluconazole > 200 mg
▪
oxcarbazepine
▪
fosamprenavir
▪
phenobarbital
▪
grapefruit
▪
phenytoin
▪
idealisib
▪
primidone
▪
indinavir
▪
rifabutin
▪
itraconazole
▪
rifampicin
▪
ketoconazole
▪
semagacestat
▪
lopinavir
▪
talviraline
▪
miconazole
▪
thioridazine
▪
nefazodone
▪
troglitazone
▪
nelfinavir
▪
vemurafenib
▪
posaconazole
▪
ritonavir
▪
saquinavir
▪
telaprevir
▪
telithromycin
▪
tipranavir
▪
troleandomycin
▪
voriconazole

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16.2
Calculating the Child Pugh score
The severity of liver disease (Table 16–2) will determine the Child Pugh score (Table 16–3).
Table 16–2
Grading of severity of liver disease (adapted from (56))
Factor
+1
+2
+3
Bilirubin (mg/dL)
< 2
2 – 3
> 3
Albumin (g/dL)
> 3.5
2.8 – 3.5
< 2.8
International Normalized Ratio
< 1.7
1.7 – 2.3
> 2.3
Ascites
None
Mild
Moderate / Severe
Encephalopathy
None
Grade I - II
Grade III – IV
Table 16–3
Classification using the added score from Table 16–2 (adapted from (56))
Child-Pugh Class
A
B
C
Points
5 6
7 – 9
10 15
16.3
HRQoL questionnaires
KDQOL-36 is a specific measure of health-related quality of life for CKD that includes 
effects and burden of kidney disease as well as physical and mental health scores. 
Two forms of the KDQOL exist: the KDQOL-SF and the KDQOL-36. Both were developed 
by the Kidney Disease Quality of Life Working Group at RAND Corporation. The 
KDQOL-SF is based on the SF-36 with additional questions specific to kidney disease 
concerning symptoms and problems, effects of kidney disease on daily life, burden of 
kidney disease, cognitive function, work status, sexual function, quality of social interaction, 
and sleep (57). It was developed for use with a dialysis patient population but it has also been 
found to be valid and reliable in a kidney transplant patient population (58). Studies using the 
KDQOL revealed that psychological factors, including depression, were a much stronger 
determinant of quality of life than biological measures like dialysis adequacy (59). While the 
KDQOL-SF has 134 questions the shorter form KDQOL-36 consists of 36 questions and 
contains the SF-12. The items of the KDQOL-36 are grouped as shown in Table 16–4.
The EQ-5D-5L was introduced in 2005. The EQ-5D-5L still consists of 2 pages: the 
EQ-5D-5L descriptive system and the EQ Visual Analogue scale (EQ VAS). 
The descriptive system comprises the same 5 dimensions as the EQ- 5D-3L (mobility, 
self-care, usual activities, pain/discomfort, anxiety/depression). However, each dimension 
now has 5 levels: no problems, slight problems, moderate problems, severe problems, and 
extreme problems.

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Table 16–4
KDQOL-36: grouping of items and description
Items 1-12:
SF-12
Physical Component Summary (PCS) on physical functioning, role-physical, 
bodily pain, general health; Mental Component Summary (MCS) on 
vitality, social functioning, role-emotional, mental health
Items 13-16:
Burden of Kidney Disease (4)
Interference with daily life, time to deal with kidney disease, frustration, 
feeling like a burden
Items 17-28:
Symptoms / Problems (12)
General health, activity limits, ability to accomplish desired tasks, 
depression/anxiety, energy level, social activities 
Items 29-36:
Effects of Kidney Disease (8)
Impact of fluid & diet limits, ability to work around the house and to travel, 
feeling depending on medical team, stress or worries, sex life, personal 
appearance
16.4
Definition of cardiovascular disease (CVD) – new section
This section was added in Amendment 3.
The definition of cardiovascular disease for stratification purposes in the study is presented in 
Table 16–5. If any of these conditions below is fulfilled at Screening Visit, subject should be 
stratified as having history of cardiovascular disease in the study.
Table 16–5
Definition of cardiovascular disease for stratification purposes
Coronary Artery Disease:

Previous Myocardial Infarction (MI) 

History of coronary revascularization (percutaneous coronary intervention or coronary artery bypass 
graft)

Angiographically proven stenosis ≥ 50% in at least one major epicardial coronary artery
Cerebrovascular Disease:

Previous ischemic stroke [transient ischemic attack (TIA) alone not sufficient to fulfill this criterion]
Peripheral Arterial Disease:

Previous non-traumatic leg amputation

History of lower-limb revascularization (either surgical or percutaneous)

History of intermittent claudication with ankle brachial pressure index (ABPI) of ≤ 0.80 in at least one side

Previous carotid endarterectomy or carotid stenting