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June 7, 2026Diabetes

Conventional dose ARB plus finerenone shows no benefit over high-dose ARB for cardio-renal markers.

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Why the study?

The study was conducted to compare the efficacy of conventional dose ARB plus finerenone versus high-dose ARB alone on cardio-renal markers in patients with type 2 diabetes and stage 1-3 diabetic nephropathy.

Does conventional dose ARB plus finerenone improve cardio-renal markers compared to high-dose ARB in T2DM patients with stage 1-3 diabetic nephropathy receiving SGLT2 inhibitors?

Population

112 T2DM patients aged <75 years with stage 1-3 diabetic nephropathy receiving SGLT2i

Comparison

Conventional dose ARB plus finerenone vs high-dose ARB alone

Design

Propensity score-matched retrospective cohort study

Follow-up

6 mths

Key result

Conventional dose ARB plus finerenone showed no significant difference in cardio-renal markers, including UACR (difference -20.48; p=0.545) and eGFR (difference -0.971; p=1), compared to high-dose ARB.

Authors

VGVISHAL GUPTA

Discussion

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Overview

Should not yet change ARB dosing in T2DM nephropathy on SGLT2 inhibitors; leaves open finerenone benefit in randomized trials.

Key Points

  • The aim was to evaluate the efficacy of combined finerenone with conventional dose ARBs compared to high-dose ARBs on cardio-renal markers in T2DM patients with diabetic nephropathy.
  • 112 T2DM patients aged <75 years with stage 1-3 diabetic nephropathy were analyzed.
  • Patients receiving SGLT2 inhibitors were divided into two groups: CDARB + Fi and HDARB, with propensity score matching for baseline characteristics.
  • Data analysis was performed using SPSS version 27 with various statistical tests.
  • No significant changes in cardio-renal markers over 6 months between the two groups.
  • Both groups demonstrated similar reductions in UACR, TC, and LDL at 6 months.
  • Systolic blood pressure was significantly lower in the combined therapy group at baseline.

Study Design

Type

Observational (n=112)

Structured PICO

Does conventional dose ARB plus finerenone improve cardio-renal markers compared to high-dose ARB in T2DM patients with stage 1-3 diabetic nephropathy receiving SGLT2 inhibitors?

P
Population
112 T2DM patients aged <75 years with stage 1-3 diabetic nephropathy receiving SGLT2i, retrospectively analyzed over 6 months.
E
Exposure
Conventional dose ARB (valsartan ≤160mg/d or telmisartan ≤80mg/d) plus finerenone (Group A, n=62)
C
Comparator
High dose ARB alone (valsartan >160mg/d or telmisartan >80mg/d) (Group B, n=50)
O
Outcome
Cardio-renal markers (Cr, eGFR, UACR, SBP/DBP, BMI, Lipid profile, hs-CRP) analyzed 2-3 monthly for 6 monthssurrogate

Main Result

Mean Difference: -20.48

p-value: p=0.545

Up-titration of ARB is as effective as adding finerenone to conventional dose ARB for improving renal markers over 6 months in T2DM patients with stage 1-3 diabetic nephropathy on SGLT2 inhibitors.

Cite This Study

VISHAL GUPTA (2026) conducted an observational in Type 2 Diabetes Mellitus with stage 1-3 diabetic nephropathy (n=112). Conventional dose ARB + Finerenone vs. High dose ARB alone (Valsartan >160mg/d or telmisartan >80mg/d) was evaluated on Differences in cardio-renal markers at 6 months (MD -20.48 (for UACR), p=0.545). Conventional dose ARB plus finerenone showed no significant difference in cardio-renal markers, including UACR (difference -20.48; p=0.545) and eGFR (difference -0.971; p=1), compared to high-dose ARB.

synapsesocial.com/papers/6a250c7d7def13d035e1c96fhttps://doi.org/10.2337/db26-1393-p
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Finerenone-Based Dual Versus Triple Therapy with SGLT2 Inhibitors and GLP-1 Receptor Agonists in Type 2 Diabetes Mellitus Associated Chronic Kidney Disease: A Retrospective Cohort Study2026
  2. 2Comparative Evaluation of ARB Monotherapy and SGLT2/ACE Inhibitor Combination Therapy in the Renal Function of Diabetes Mellitus Patients: A Retrospective, Longitudinal Cohort Study2025
  3. 3Effect of finerenone on renal function in patients with type 2 diabetic nephropathy: a retrospective cohort study2026
  4. 4Prevention of new-onset heart failure and renoprotective effect with sodium-glucose cotransporter 2 inhibitors in patients with chronic kidney disease2025
  5. 5Adding Finerenone to <scp>SGLT2</scp> Inhibitors and Long‐Term Kidney Outcomes in Diabetic Kidney Disease2026