Adding finerenone to RASi and SGLT2i therapy in patients with diabetic kidney disease significantly attenuated annual eGFR decline by 1.45 mL/min/1.73 m2/year (95% CI 0.32-2.58; p=0.012).
Cohort (n=255)
Does adding finerenone to RASi and SGLT2i therapy improve proteinuria and eGFR slope in patients with diabetic kidney disease?
Adding finerenone to RASi and SGLT2i therapy in patients with diabetic kidney disease significantly reduces proteinuria and attenuates long-term eGFR decline without a significant long-term increase in serum potassium.
Mean Difference: 1.45 (95% CI 0.32–2.58)
p-value: p=0.012
ABSTRACT Background Despite treatment with renin–angiotensin system inhibitors (RASis) and sodium–glucose cotransporter 2 inhibitors (SGLT2is), diabetic kidney disease (DKD) continues to exhibit substantial residual renal risk. The renoprotective effects of adding finerenone to dual therapy remain incompletely characterised. Methods A total of 255 patients with DKD receiving combined RASi and SGLT2i therapy were analysed by intention‐to‐treat as triple combination therapy (TCT) with finerenone or dual combination therapy (DCT) alone. The outcomes were longitudinal changes in proteinuria, serum potassium and estimated glomerular filtration rate (eGFR) slope, including total eGFR slope over 24 months and the post–initial dip eGFR slope from 3 to 24 months, evaluated before and after propensity score (PS) matching. Results Over a 24‐month follow‐up period, TCT was associated with a greater and sustained reduction in proteinuria compared with DCT, with significant reductions of 47% at 24 months ( p = 0.028). Although the total eGFR slope did not differ significantly between groups, the post–initial dip slope was significantly improved in the TCT group, with an attenuation of annual eGFR decline by approximately 1.31 mL/min/1.73 m 2 /year (95% CI: 0.25 to 2.36) compared with DCT ( p = 0.015). After PS matching, this association remained significant (between‐group difference 1.45 mL/min/1.73 m 2 /year; 95% CI: 0.32–2.58; p = 0.012). Serum potassium increased modestly in the early phase of TCT but stabilised thereafter, with no significant difference between groups at 24 months. Conclusions Among patients with DKD receiving RASi and SGLT2i therapy, the addition of finerenone was associated with greater proteinuria reduction and a significant improvement in the post–initial dip eGFR slope, suggesting that TCT may offer an additional renoprotective strategy in DKD.
Matsui et al. (Sun,) conducted a cohort in Diabetic Kidney Disease (n=255). Finerenone vs. Dual combination therapy (RASi and SGLT2i alone) was evaluated on post-initial dip eGFR slope from 3 to 24 months (MD 1.45, 95% CI 0.32-2.58, p=0.012). Adding finerenone to RASi and SGLT2i therapy in patients with diabetic kidney disease significantly attenuated annual eGFR decline by 1.45 mL/min/1.73 m2/year (95% CI 0.32-2.58; p=0.012).