Residual renal risk remains substantial in patients with diabetic kidney disease (DKD) despite treatment with renin–angiotensin system inhibitors (RASis) and sodium-glucose cotransporter 2 inhibitors (SGLT2is). A longitudinal analysis published in Diabetes, Obesity and Metabolism evaluated whether adding finerenone to dual therapy could provide additional renal benefit in patients with DKD.
The intention-to-treat analysis included 255 patients with DKD receiving either triple combination therapy (TCT) with finerenone plus RASi and SGLT2i therapy or dual combination therapy (DCT) alone. Outcomes included longitudinal changes in proteinuria, serum potassium levels, and estimated glomerular filtration rate (eGFR) slope over 24 months. The analysis also evaluated post–initial dip eGFR slope from months 3 to 24 and included propensity score-matched comparisons.
Findings
- Triple combination therapy with finerenone led to greater proteinuria reduction than dual therapy alone, including a 47% reduction at 24 months (P=0.028).
- Total estimated glomerular filtration rate (eGFR) slope over 24 months did not differ significantly between groups. However, triple therapy improved the post–initial dip eGFR slope, attenuating annual eGFR decline by 1.31 mL/min/1.73 m²/year versus dual therapy (95% CI 0.25-2.36; P=0.015).
- After propensity score matching, the improvement in post-initial dip eGFR slope remained significant, with a between-group difference of 1.45 mL/min/1.73 m²/year (95% CI 0.32-2.58; P=0.012).
- Serum potassium increased modestly early after finerenone initiation but stabilized during follow-up, with no significant difference between groups at 24 months.
The findings suggested that adding finerenone to RASi and SGLT2i therapy may provide additional renoprotective benefit in patients with DKD. The analysis also indicated that improvement in post–initial dip eGFR slope may become more apparent during longer-term follow-up.
