# What does finerenone add in chronic kidney disease with type 2 diabetes?

Canonical page: https://cliniatlas.com/evidence/finerenone-chronic-kidney-disease-type-2-diabetes/

**Summary:** Slower kidney disease progression and fewer cardiovascular events, on top of maximally tolerated RAS blockade.

FIDELIO-DKD randomised 5,734 patients with chronic kidney disease and type 2 diabetes, already on maximally tolerated renin-angiotensin system blockade, to finerenone or placebo. The primary composite of kidney failure, sustained eGFR decline of at least 40%, or renal death was significantly lower with finerenone [1].

FIGARO-DKD enrolled a broader population weighted toward earlier kidney disease and higher cardiovascular risk, and found a significant reduction in its primary cardiovascular composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalisation for heart failure [2]. The two trials are complementary: kidney-weighted and cardiovascular-weighted respectively.

Finerenone is a selective non-steroidal mineralocorticoid receptor antagonist, pharmacologically distinct from spironolactone and eplerenone. Hyperkalaemia was more frequent than with placebo in both trials and is the main monitoring requirement in practice [1, 2].

## Limitations

- Both trials required patients to tolerate maximally tolerated RAS blockade, so results describe added benefit rather than standalone therapy.
- Hyperkalaemia risk means potassium monitoring is required, and patients with high baseline potassium were excluded from enrolment.

## Sources

1. [IV / Randomised trial] Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. New England Journal of Medicine (2020). PMID 33264825. https://pubmed.ncbi.nlm.nih.gov/33264825/
2. [IV / Randomised trial] Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. New England Journal of Medicine (2021). PMID 34449181. https://pubmed.ncbi.nlm.nih.gov/34449181/

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