Combination Therapy of Finerenone and Empagliflozin to Manage Kidney Health in Patients with Type 2 Diabetes and Chronic Kidney Disease
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on September 1st, 2025
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Sodium–glucose cotransporter-2 (SGLT2) inhibitors and nonsteroidal mineralocorticoid receptor antagonists are frequently used in patients with chronic kidney disease and type 2 diabetes. The effectiveness of these monotherapy is clearly understood, but little is known about the combination effect. With funding from Bayer, a study was conducted to assess the dual usage of these medications to prevent kidney disease progression.
The clinical study included 800 participants with an average age of 66.5 years old who had been diagnosed with type 2 diabetes and chronic kidney disease. The patients had a mean glycated hemoglobin level of 7.3%, and an estimated glomerular filtration rate of 54.2. Their median urinary albumin-to-creatinine ratio was 579 and their mean serum potassium was 4.5. Almost all of the participants were treated with an ACE inhibitor, and 40% were using insulin. With diuretics and glucagon receptor agonists used by 36.1% and 22.8%, respectively
The participants were randomly assigned to be treated daily with 10 mg of finerenone, 10 mg of empagliflozin, or a combination of both. Finerenone is a nonsteroidal mineralocorticoid receptor antagonists that counteract the effects of aldosterone and increase urine production. Empaglifolizin prevents the reabsorption of sodium and glucose that would lead to water retention.
After 180 days of treatment, the researchers found that the combination of empagliflozin and finerenone reduced the urinary albumin-to-creatinine ratio by around 50%; this reduction is significantly more than those treated with the monotherapy. The combination therapy was also effective at reducing systolic blood pressure and stabilizing glomerular filtration rate and increasing serum potassium level. However, the increase in potassium retention leads to a higher frequency of hyperkalemia in these patients. The researchers also noted that combining finerenone and empagliflozin might be more effective than administering the medication sequentially, as recommended in many clinical guidelines.
The clinical study included 800 participants with an average age of 66.5 years old who had been diagnosed with type 2 diabetes and chronic kidney disease. The patients had a mean glycated hemoglobin level of 7.3%, and an estimated glomerular filtration rate of 54.2. Their median urinary albumin-to-creatinine ratio was 579 and their mean serum potassium was 4.5. Almost all of the participants were treated with an ACE inhibitor, and 40% were using insulin. With diuretics and glucagon receptor agonists used by 36.1% and 22.8%, respectively
The participants were randomly assigned to be treated daily with 10 mg of finerenone, 10 mg of empagliflozin, or a combination of both. Finerenone is a nonsteroidal mineralocorticoid receptor antagonists that counteract the effects of aldosterone and increase urine production. Empaglifolizin prevents the reabsorption of sodium and glucose that would lead to water retention.
After 180 days of treatment, the researchers found that the combination of empagliflozin and finerenone reduced the urinary albumin-to-creatinine ratio by around 50%; this reduction is significantly more than those treated with the monotherapy. The combination therapy was also effective at reducing systolic blood pressure and stabilizing glomerular filtration rate and increasing serum potassium level. However, the increase in potassium retention leads to a higher frequency of hyperkalemia in these patients. The researchers also noted that combining finerenone and empagliflozin might be more effective than administering the medication sequentially, as recommended in many clinical guidelines.