finerenone for treating chronic kidney disease in type 2 diabetes

Last edited 03/2023 and last reviewed 10/2023

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

Reference:

Related pages:

SGLT2 inhibitors in the management of proteinuria

ACE inhibitors in chronic kidney disease (CKD)

Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) trial