Finerenone: Towards a holistic therapeutic approach to patients with diabetic kidney disease

Despite current treatments, that include renin angiotensin system blockers and SGLT2 inhibitors, the risk of renal disease progression among patients with diabetes and chronic kidney disease (CKD) remains unacceptably high. The pathogenesis of CKD in patients with diabetes is complex and includes hemodynamic and metabolic factors, as well as inflammation and fibrosis. Finerenone is a nonsteroidal highly selective mineralocorticoid antagonist that, in contrast to current therapies, may directly reduce inflammation and fibrosis, supporting an added value in the management of these patients. In fact, finerenone decreased albuminuria and slowed CKD progression in persons with diabetes. We now review the mechanisms of action of finerenone, the results of recent clinical trials and a practical approach to integrate the kidney and cardiovascular protection afforded by finerenone in the routine care of patients with diabetes and CKD.(c) 2022 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY license .

Automated summary

Despite current treatments, the risk of renal disease progression among patients with diabetes and CKD remains high. Finerenone, a nonsteroidal highly selective mineralocorticoid antagonist, may directly reduce inflammation and fibrosis, and has shown promising results in reducing albuminuria and slowing CKD progression in persons with diabetes.