N Engl J Med

ERS 2025: Dual therapy reduces albuminuria in CKD patients with T2DM

June 9, 2025

The complementary use of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, and empagliflozin, an SGLT2 inhibitor, in patients with chronic kidney disease (CKD) and T2DM reduces both renal and cardiovascular risk, reinforcing a dual-mechanism approach to disease modification. These results were reported at the European Renal Association (ERA) annual congress.

Study details: The randomized, double-blind, placebo-controlled CONFIDENCE trial evaluated the combined effect of finerenone and empagliflozin in 818 patients with CKD and T2DM. Participants were already receiving optimized renin–angiotensin system blockade. The primary outcome was a composite of kidney failure, sustained ≥40% decline in eGFR, or renal death.

Results: At baseline, urinary albumin-to-creatinine ratios were comparable across groups. By day 180, combination therapy with finerenone and empagliflozin led to significantly greater reductions in albuminuria—29% more than finerenone alone (mean ratio 0.71; 95% confidence interval [CI], 0.61–0.82; P < 0.001) and 32% more than empagliflozin alone (mean ratio 0.68; 95% CI, 0.59–0.79; P < 0.001). The safety profile was favorable across all groups, with low rates of symptomatic hypotension, acute kidney injury, and hyperkalemia-related discontinuation.

Source:

Agarwal R, et al; CONFIDENCE Investigators. (2025, June 5). N Engl J Med. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/40470996/