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
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.
Agarwal R et al. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes. NEJM June 5th 2025.
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