Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) plus a sodium-glucose cotransporter 2 (SGLT2) inhibitor are generally used to treat patients with type 2 diabetes and diabetic kidney disease (DKD).

Finerenone is a nonsteroidal selective mineralocorticoid receptor antagonist and can slow the progression of kidney function loss as shown in a large clinical trial of patients with type 2 diabetes and severe DKD. In another trial on patients with less severe DKD, finerenone reduced the risk of hospitalization due to heart failure and brought about a non-significant decrease in the rate of kidney failure and all-cause mortality. 

Besides, the benefit of finerenone was equally seen in patients who were treated with or not treated with an SGLT2 inhibitor. These results have led to the recommendation of adding finerenone to SGLT2 inhibitor therapy in patients if the patients have optimal levels of serum potassium while taking an ACE inhibitor or ARB,

Reference: 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: 2252.