Finerenone with empagliflozin in CKD with diabetes (CONFIDENCE): only a blood pressure effect? Likely!
Abstract
Chronic kidney disease (CKD) in persons with diabetes mellitus (DM) continues to be the leading cause of end-stage kidney disease (ESKD) worldwide. Despite the use of reninangiotensin system blockade, sodium-glucose transport protein 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists the risk of progression to ESKD and CV events persists in this high-risk population. For this reason, new or combined strategies for treating persons with CKD and DM are in constant development. This editorial discusses the results of a recent published trial, Combination Effect of Finerenone and Empagliflozin (EMP) in Participants with Chronic Kidney Disease and Type 2 Diabetes Using a Urinary Albumin-to-Creatinine Ratio (UACR) Endpoint (CONFIDENCE) in persons with DM and CKD focused in the mechanisms involved in the beneficial renal effect in terms of albuminuria reduction[1]. Whether there is related to the synergistic effect of the combination therapy (EMP + finerenone) or merely a manifestation secondary to systolic blood pressure (SBP) reduction remains to be determined[2].The CONFIDENCE trial, a double-blind, multicenter, study involving 800 patients with type 2 DM and CKD (eGFR 30 to 90 ml/min/1.73m 2 and urinary albumin-to creatinine ratio (UACR) 100 to < 5000 mg/g) tested the effect of combining finerenone and EMP on reducing albuminuria compared with monotherapy with either empagliflozin or finerenone alone, over…
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