Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Sep 29;40(10):1897-1905.
doi: 10.1093/ndt/gfaf064.

Cardio-kidney outcomes for combined versus monotherapy with finerenone or SGLT2 inhibitors in patients with CKD

Min-Hsiang Chuang  1 , Hsien-Yi Wang  1   2 , Wei-Chih Kan  1   3 , Chih-Chiang Chien  1 , Ming-Yan Jiang  1 , Yun-Ting Huang  1 , Vin-Cent Wu  4   5 , Jui-Yi Chen  1   6
Affiliations
Observational Study

Cardio-kidney outcomes for combined versus monotherapy with finerenone or SGLT2 inhibitors in patients with CKD

Min-Hsiang Chuang et al. Nephrol Dial Transplant. .

Abstract

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and finerenone each improve kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD). This study compares the association between combined therapy versus monotherapy with SGLT2i or finerenone and the kidney, cardiovascular and mortality outcomes in CKD patients.

Methods: This retrospective cohort study included adults ≥18 years with CKD between 9 July 2021, and 30 November 2023 from multiple centers in the USA, utilizing the TriNetX database. Exposures included treatment with finerenone, SGLT2i or a combination of both. The primary outcome was major adverse kidney events (MAKE). Secondary outcomes included all-cause mortality, major adverse cardiac events (MACE) and end-stage renal disease (ESRD).

Results: A total of 853 patients were included in the combined group [mean (±standard deviation) age, 66.7 ± 11.4 years; 34.9% female], 942 in the finerenone group (mean age, 68.2 ± 11.4 years; 45.8% female) and 45 948 in the SGLT2i group (mean age, 70.2 ± 11.8 years; 41.4% female). After matching, the combined group had less MAKE compared with finerenone monotherapy [adjusted hazard ratio (aHR) 0.20; 95% confidence interval (CI) 0.09-0.45] or SGLT2i monotherapy (aHR 0.44; 95% CI 0.22-0.89). The hazards of all-cause mortality and ESRD were also lower in the combined group compared with either finerenone or SGLT2i alone, while hazard of MACE was similar between the combined and monotherapy groups. The combined group had higher risk of hyperkalemia compared with SGLT2i monotherapy (aHR = 1.36; 95% CI 1.08-1.71).

Conclusion: Combined therapy with finerenone and SGLT2i is associated with less MAKE and all-cause mortality in CKD patients compared with monotherapy. However, the risk of hyperkalemia with finerenone warrants caution.

Keywords: chronic kidney disease; finerenone; major adverse cardiac events; mortality; sodium-glucose cotransporter 2 inhibitors.

PubMed Disclaimer

Conflict of interest statement

No conflicts of interest exist for any of the authors.

Figures

Figure 1:
Figure 1:
Flowchart of cohort construction.
Figure 2:
Figure 2:
Forest plot of primary and secondary outcomes.
Figure 3:
Figure 3:
Kaplan–Meier curves of MAKE (a) between the combined and finerenone groups (log-rank test P < .001) and (b) between the combined and SGLT2i groups (log-rank test P = .020).
See this image and copyright information in PMC

References

    1. Kalantar-Zadeh K, Jafar TH, Nitsch D et al. Chronic kidney disease. Lancet 2021;398:786–802. 10.1016/S0140-6736(21)00519-5 - DOI - PubMed
    1. Matsushita K, van der Velde M, Astor BC et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010;375:2073–81. - PMC - PubMed
    1. Cowie MR, Fisher M. SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nat Rev Cardiol 2020;17:761–72. 10.1038/s41569-020-0406-8 - DOI - PubMed
    1. Thomson SC, Rieg T, Miracle C et al. Acute and chronic effects of SGLT2 blockade on glomerular and tubular function in the early diabetic rat. Am J Physiol-Regul, Integr Comp Physiol 2012;302:R75–83. 10.1152/ajpregu.00357.2011 - DOI - PMC - PubMed
    1. Perkovic V, Jardine MJ, Neal B et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019;380:2295–306. 10.1056/NEJMoa1811744 - DOI - PubMed

MeSH terms