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Review
. 2025 Jun 2:12:1580645.
doi: 10.3389/fmed.2025.1580645. eCollection 2025.

Finerenone in diabetic kidney disease: a new frontier for slowing disease progression

Ibrahim S Alhomoud  1 , Mohamed A Albekery  2 , Razan Alqadi  3 , Amal Alqumia  4 , Riaz A Khan  5 , Muthana Al Sahlawi  6 , Mohammed Yousef Al Mulhim  6
Affiliations
Review

Finerenone in diabetic kidney disease: a new frontier for slowing disease progression

Ibrahim S Alhomoud et al. Front Med (Lausanne). .

Abstract

Diabetic kidney disease (DKD) represents a substantial health burden for patients with type 2 diabetes mellitus (T2DM), markedly increasing morbidity and mortality. The cornerstone of DKD treatment remains renin-angiotensin system (RAS) blockade and risk factor control, such as blood pressure management, glycemic control, albuminuria reduction, and lipid management. However, treatment strategies have expanded to include sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, which have proven effective in slowing kidney disease progression when combined with RAS inhibitors. Finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), represents a novel approach to the management of DKD. It offers unique pharmacokinetic and pharmacodynamic properties compared with steroidal MRAs such as spironolactone and eplerenone. This review addresses the evolving landscape of diabetic kidney disease management, with a focus on finerenone's distinct pharmacologic properties, structural characteristics, and clinical implications.

Keywords: chronic kidney disease (CKD); diabetes mellitus; diabetic kidney disease (DKD); finerenone; mineralocorticoid receptor antagonists (MRA).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Chemical structures of aldosterone, spironolactone, eplerenone, and finerenone (54).
FIGURE 2
FIGURE 2
The place of finerenone therapy in the management landscape of diabetic kidney disease in patients with type 2 diabetes mellitus.
See this image and copyright information in PMC

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