Real-World Effectiveness of Finerenone Added to SGLT2 Inhibitor and GLP-1 Receptor Agonist Therapy in Individuals with Type 2 Diabetes and Chronic Kidney Disease

Background/Objectives: Recent randomized controlled trial evidence in adults with type 2 diabetes (T2D) and chronic kidney disease (CKD) indicates that adding finerenone to empagliflozin provides additive clinical benefit. A prespecified analysis demonstrates that this benefit is consistent irrespective of prior glucagon-like peptide-1 receptor agonist (GLP-1 RA) use. We aimed to assess the effectiveness of adding finerenone to existing sodium-glucose cotransporter-2 inhibitor (SGLT2i) and GLP-1 RA therapy in a real-world setting. Methods: We performed a retrospective cohort study of adults with T2D and CKD from Maccabi Healthcare Services diabetes, endocrinology, and nephrology clinics in Haifa, Israel. Included individuals initiated finerenone between 1 August 2023, and 31 January 2025, and met the following criteria: estimated glomerular filtration rate (eGFR) of 25–60 mL/min/1.73 m²; urinary albumin-to-creatinine ratio (UACR) > 300 mg/g; and a history of ≥12 weeks of SGLT2i (empagliflozin or dapagliflozin) and GLP-1 RA (liraglutide, dulaglutide, or semaglutide) use prior to finerenone initiation. Outcomes were assessed at the last measurement taken within 26 ± 10 weeks of finerenone initiation. The primary outcome was adjusted percent change in log-transformed UACR from baseline to follow-up. Secondary outcomes were adjusted mean changes in eGFR and serum potassium. We used multiple linear regression models. Prespecified subgroup analyses examined the UACR change by age, sex, body mass index (BMI), baseline eGFR, and baseline UACR. Results: Fifty-one individuals were included in the study, with a mean age of 66.0 ± 9.5 years and a mean BMI 30.9 ± 5.2 kg/m². The median eGFR was 45 mL/min/1.73 m² (IQR 36–52), and the median UACR was 1001 mg/g (IQR 515–1599). 94% were receiving a renin–angiotensin system inhibitor. Finerenone was initiated at 10 mg/day and titrated to 20 mg/day in eight individuals. Over a median follow-up of 27 weeks, the adjusted percent change in UACR was −51.3% (p < 0.001), consistent across prespecified subgroups. The adjusted mean eGFR change was −3.92 mL/min/1.73 m² (p < 0.001). Serum potassium increased by +0.34 mmol/L (p < 0.001). Conclusions: In adults with T2D and albuminuric CKD already receiving an SGLT2i and a GLP-1 RA, adding finerenone substantially reduced albuminuria.