Finerenone for treating chronic kidney disease in type 2 diabetes

NICE guidance states:

• finerenone is recommended as an option for treating stage 3 and 4 chronic kidney disease (with albuminuria) associated with type 2 diabetes in adults
  • is recommended only if:
    • it is an add-on to optimised standard care; this should include, unless they are unsuitable, the highest tolerated licensed doses of:
      • angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and
      • sodium–glucose cotransporter-2 (SGLT2) inhibitors and
    • the person has an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m² or more
• the NICE committee stated:
  • standard care for chronic kidney disease in people with type 2 diabetes includes ACE inhibitors and ARBs, with SGLT2 inhibitors being added if needed
    • finerenone would be added to ACE inhibitors and ARBs if they are not working well enough
      • could be offered before, after, or with SGLT2 inhibitors
    • clinical evidence suggests that finerenone improves kidney function and helps to slow the worsening of the disease compared with placebo (both plus standard care, with and without SGLT2 inhibitors)
    • are no direct comparisons of finerenone against SGLT2 inhibitors when used as an add-on to standard care (without SGLT2 inhibitors)
• evidence shows that patients with T2DM and CKD, who received finerenone had a significant lower risk of a primary kidney event compared to patients treated with placebo (2)
  • also a composite of CV events was reduced by finerenone in these patients when compared to placebo
• combination of finerenone and an SGLT2 inhibitor
  • among persons with both chronic kidney disease and type 2 diabetes, initial therapy with finerenone plus empagliflozin led to a greater reduction in the urinary albumin-to-creatinine ratio than either treatment alone

References:

1. NICE (March 2023). Finerenone for treating chronic kidney disease in type 2 diabetes.
2. Bakris GL, Agarwal R, Anker SD, et al.Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Eng J Med, 2020, DOI: 10.1056/NEJMoa2025845.
3. Agarwal R et al. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes. NEJM June 5th 2025.