Enhanced Effectiveness of Combination Therapy in Reducing Albuminuria for CKD and Type 2 Diabetes Patients

Recent findings from the CONFIDENCE trial highlight that combining finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, with the SGLT2 inhibitor empagliflozin results in significantly greater reductions in albuminuria among patients suffering from chronic kidney disease (CKD) with type 2 diabetes (T2D). Presented at the 62nd ERA Congress and published in the New England Journal of Medicine, this study suggests a promising shift in treatment strategy for high-risk CKD patients.

Albuminuria, an early marker of CKD, indicates disease progression and increased cardiovascular risk. Both finerenone and empagliflozin have independently demonstrated benefits in delaying kidney deterioration and improving cardiovascular health. This trial is groundbreaking as it investigates the impact of using both agents simultaneously, aiming for superior kidney protection.

The phase 2, multicenter, double-blind trial involved 818 adults across 143 international sites, all with CKD and T2D, and a urinary albumin-to-creatinine ratio (UACR) between 100 and 5,000 mg/g. Participants were assigned to receive either a placebo, finerenone alone (10 or 20 mg), empagliflozin alone (10 mg), or a combination of finerenone and empagliflozin. Dosing adjustments were made based on baseline kidney function. All participants were on maximally tolerated doses of renin-angiotensin system inhibitors.

Results at 180 days showed that the combination therapy group experienced a median UACR reduction of 52%, significantly greater than the reductions seen with either drug alone—29% more than finerenone and 32% more than empagliflozin alone. This early additive effect underscores the potential of dual therapy to more effectively reduce kidney-related biomarkers.

Lead researcher Dr. Rajiv Agarwal emphasized that early, combined intervention offers substantial improvement in UACR, which is closely linked to kidney and cardiovascular outcomes. The combination therapy was well-tolerated, with low rates of adverse events such as hypotension, acute kidney injury, or hyperkalemia.

This innovative approach advocates for a paradigm shift towards proactive dual-pathway management earlier in CKD and T2D care, potentially leading to better long-term outcomes for patients at high risk of deterioration and cardiovascular events.

For detailed insights, refer to the study published in the New England Journal of Medicine (2025): [DOI: 10.1056/NEJMoa2410659].

Source: https://medicalxpress.com/news/2025-06-combination-therapy-superior-efficacy-albumin.html