Finerenone in Diabetic Kidney Disease

Diabetic kidney disease (DKD) affects 40% of individuals with diabetes mellitus (T2DM) and is associated with an increased risk of cardiovascular events, hospitalization for heart failure, and premature death. Existing treatments focus on lifestyle measures, glycemic control, blood pressure and lipid management, inhibition of the renin‑angiotensin‑aldosterone system (RAAS), and the use of sodium glucose cotransporter 2 inhibitors (SGLT2-i). However, substantial residual risk of progression to end-stage kidney disease (ESKD) or cardiovascular complications remain despite optimal therapy. Finerenone, a non-steroidal mineralocorticoid antagonist (MRA), has been shown to reduce important outcomes when added to evidence-based therapies, and is approved by Health Canada as an adjunct to standard of care therapy in adults with chronic kidney disease (CKD) and T2DM to reduce the risk of ESKD and a sustained decrease in estimated glomerular filtration rate (eGFR), cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure.