The role of finerenone in the concomitant management of chronic kidney disease-type 2 diabetes and the implication for heart failure prevention and treatment.

The nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone is indicated in the United States for use in adults with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). Results from the FIDELIO-DKD and FIGARO-DKD Phase 3 clinical trials showed a statistically significant reduction in the risk of CKD progression and cardiovascular events with finerenone versus placebo when added to maximally tolerated dose of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. The cardiovascular event risk reduction was primarily driven by the reduction in the risk of hospitalization for heart failure (HF). Recent results from the Phase 3 FINEARTS-HF trial in patients with HF with mildly reduced ejection fraction (HFmrEF) or HF with preserved ejection fraction (HFpEF) showed a significantly lower rate of a composite of total worsening HF events and death from cardiovascular causes with finerenone versus placebo. Further Phase 3 trials in additional HF populations are ongoing. The steroidal MRAs spironolactone and eplerenone are included in clinical practice guidelines for the treatment of symptomatic HF, but the highest class (grade 1) recommendations are in HF with reduced ejection fraction only. Based on the available evidence, finerenone presents as a new evidence-based therapy for HFpEF/HFmrEF in addition to its current application in CKD associated with T2D. The aim of our review article is to present the current evidence available on the potential kidney and cardioprotective effects of finerenone to inform healthcare professionals (particularly those who work in cardiology).