Finerenone is anon-steroidal selective mineralocorticoid receptor antagonist (MRA) may lead toless hyperkalaemia than steroidal MRAs. Finerenone may retain other putative benefits of antagonizing the mineralocorticoid receptor like reducing inflammation and fibrosis.

In the FIDELIO-DKD (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) trial the results of finerenone treatment led to as lower decline in estimated glomerular filtration rate and non-significantly lower rates of end-stage kidney disease and all-cause mortality. In this study, about 6000 patients with type 2 diabetes with either severely increased albuminuria or moderately increased albuminuria plus retinopathy were included. The participants were randomly assigned to finerenone or placebo.

However, the additional benefit of finerenone in patients with diabetic kidney disease on angiotensin inhibitor and a sodium glucose co-transporter 2 inhibitor has not been assessed till now and the role of finerenone in the treatment of diabetic kidney disease has not been established so far. Yet, the results of the trial established that in patients with CKD and type 2 diabetes, treatment with finerenone led to reduced risk of CKD progression and cardiovascular events compared with placebo.

Reference: BakrisGL, et al. Effect of finerenone on chronic kidney disease outcomes in type 2diabetes. N Engl J Med. 2020; 383(23): 2219.