Non-steroidal MRA for CKD & T2DM

Finerenone is the first non-steroidal mineralocorticoid-receptor antagonist (MRA) shown to protect both kidneys and heart in diabetic CKD.

Mechanism of Action

Finerenone selectively blocks the mineralocorticoid receptor, dampening inflammation and fibrosis in the kidney & myocardium.

Indications & Dosing

FDA-approved for CKD + T2DM with UACR ≥ 30 mg/g and eGFR ≥ 25 :KDIGO guideline

Monitoring / Safety

✅ Hyperkalemia: check K⁺ at baseline, 4 weeks, then every 3-6 months

✅ Hold / reduce if K⁺ > 5.5 mEq/L

✅ Avoid strong CYP3A4 inhibitors.

Key Trials

Pearl: Finerenone can be added on top of an SGLT-2 inhibitor for additive renal/CV protection (CONFIDENCE study).

Quick Benefits

• 🩺 Renal: Slows CKD progression (↓ UACR, ↓ eGFR decline)..
• 💓 Cardio: : Reduces CV death, HF hospitalization, and nonfatal MI/stroke..

• Instagram
• Pinterest

References

1. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease Stevens, Paul E. et al. Kidney International, Volume 105, Issue 4, S117 – S314
2. Pitt B, Filippatos G, Agarwal R, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021;385(24):2252-2263. doi: 10.1056/NEJMoa2110956.
3. Ruilope LM, Pitt B, Anker SD, et al. Kidney outcomes with finerenone: an analysis from the FIGARO-DKD study. Nephrol Dial Transplant. 2023;38(2):372–383. doi: 10.1093/ndt/gfac157
4. Agarwal, R., Green, J. B., Heerspink, H. J. L., Mann, J. F. E., McGill, J. B., Mottl, A. K., Rosenstock, J., Rossing, P., Vaduganathan, M., Brinker, M., Edfors, R., Li, N., Scheerer, M. F., Scott, C., & Nangaku, M. (2025). Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes. New England Journal of Medicine. https://doi.org/10.1056/nejmoa2410659