Efficacy of finerenone in reducing proteinuria in diabetic kidney disease on dapagliflozin and telmisartan: A disease-modifying approach

With the alarming rise in the global prevalence of the disease, type 2 diabetes mellitus (T2DM) has recently become the leading cause of chronic kidney disease (CKD) worldwide. Proteinuria, the earliest and common indicator of diabetic kidney disease (DKD), not only increases the risk of progression of CKD to end-stage renal disease (ESRD) but also multiplies the risk of cardiovascular (CV) disease in patients with diabetes. Medications such as angiotensin-converting enzyme inhibitors (ACEis), angiotensin II receptor blockers (ARBs), sodium-glucose cotransporter-2 inhibitors (SGLT-2is), and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce proteinuria and therefore possess disease-modifying properties in patients with DKD. Clinical trials have demonstrated the efficacy of finerenone, a highly selective, non-steroidal MRA, in reducing renal and CV outcomes in patients with long-standing T2DM. The benefits of various SGLT-2is have also been observed in multiple studies. Therefore, a combination of these medications, with independent but complementary mechanisms of action, could provide superior benefits as add-on therapies to ACEis/ARBs rather than using either alone. This Opinion Review explores disease-modifying strategies in patients with DKD based on the most up-to-date evidence.