Cardio-kidney outcomes for combined versus monotherapy with finerenone or SGLT2 inhibitors in patients with CKD
In a large real-world cohort of CKD patients, combining finerenone with an SGLT2 inhibitor was associated with substantially fewer major adverse kidney events, lower mortality, and less progression to end-stage renal disease than either drug alone — at the cost of more hyperkalemia versus SGLT2-inhibitor monotherapy.
Background
SGLT2 inhibitors and finerenone each improve kidney and cardiovascular outcomes in CKD through complementary mechanisms, but whether combining them adds benefit over monotherapy in routine practice was unclear.
Study design
Retrospective cohort using the multicenter US TriNetX database, including adults with CKD (2021–2023) treated with finerenone, an SGLT2 inhibitor, or both (853 combined, 942 finerenone, 45,948 SGLT2 inhibitor). After propensity matching, the primary outcome was major adverse kidney events (MAKE); secondary outcomes were all-cause mortality, major adverse cardiac events (MACE), and end-stage renal disease.
Key findings
Combined therapy was associated with fewer MAKE than finerenone monotherapy (adjusted HR 0.20, 95% CI 0.09–0.45) or SGLT2-inhibitor monotherapy (aHR 0.44, 95% CI 0.22–0.89). All-cause mortality and end-stage renal disease were also lower with combined therapy, while MACE was similar across groups. Hyperkalemia risk was higher with combined therapy than SGLT2-inhibitor monotherapy (aHR 1.36, 95% CI 1.08–1.71).
Clinical implications
These observational data support a pillared, combination approach to CKD with finerenone plus an SGLT2 inhibitor for greater kidney and survival protection, while underscoring the need for potassium monitoring. As a retrospective study it is hypothesis-generating and awaits confirmation in randomized trials.
Category
Transplant
Source
Nephrology Dialysis Transplantation
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.