Adding Finerenone to SGLT2 Inhibitors and Long-Term Kidney Outcomes in Diabetic Kidney Disease
In a 255-patient diabetic kidney disease cohort already on RAS and SGLT2 inhibitors, adding finerenone as triple therapy achieved a 47% greater reduction in proteinuria at 24 months and slowed the later eGFR decline versus dual therapy, with only a modest early rise in potassium.
Study design
A retrospective intention-to-treat cohort of 255 patients with diabetic kidney disease on combined RAS and SGLT2 inhibitor therapy compared triple therapy with finerenone against dual therapy alone, evaluating proteinuria, serum potassium and eGFR slope over 24 months before and after propensity-score matching.
Key findings
Triple therapy produced a greater and sustained proteinuria reduction, with a significant 47% reduction at 24 months (p = 0.028). The total eGFR slope did not differ significantly, but the post-initial-dip slope from 3 to 24 months improved by about 1.31 mL/min/1.73 m2/year (95% CI 0.25 to 2.36; p = 0.015); after propensity matching the difference was 1.45 mL/min/1.73 m2/year (95% CI 0.32 to 2.58; p = 0.012). Serum potassium rose modestly early but stabilised, with no significant between-group difference at 24 months.
Clinical implications
These real-world data suggest that adding finerenone to RAS plus SGLT2 inhibition offers an additional renoprotective strategy in diabetic kidney disease, consistent with the additive albuminuria reduction seen in randomized combination trials.
Category
Research
Source
Diabetes, Obesity & Metabolism
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