Finerenone Reduces Cardiovascular, Kidney Events Among Patients with T2D, CKD

Finerenone reduces cardiovascular and kidney events in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) while pushing back against cardiovascular-kidney-metabolic syndrome at every stage of severity, according to JAMA Cardiology.¹

“Substantial overlap exists among cardiovascular, kidney, and metabolic (CKM) diseases because of shared risk factors and an interconnected, interdependent pathophysiology,” according to a study published in Federal Practitioner.² “As one condition worsens, it increases the risk and severity of others, leading to a cycle of worsening outcomes and a higher risk for mortality.”

The recent study examined data from 12,990 participants across the FIDELITY trials, categorizing them into CKM stages 2, 3, and 4. Researchers found that finerenone consistently lowered the risk of the composite cardiovascular outcome—cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or heart failure (HF) hospitalization—regardless of a patient's baseline CKM stage.¹

The drug also demonstrated a consistent reduction in kidney composite outcomes, including kidney failure and a sustained 57% or greater decrease in estimated glomerular filtration rate (eGFR). After 3 years of follow-up, participants treated with finerenone were 66% more likely to experience CKM syndrome regression and significantly less likely to experience disease progression compared with those on a placebo.

READ MORE: The Role of the Pharmacist in Health Disparities in Cardiometabolic Disease

For pharmacists, these findings highlight a vital opportunity for early intervention within the CKM framework.

The Power of Finerenone in T2D and CKD

“Think of finerenone in patients with T2D and CKD and in patients with HF with left ventricular ejection fraction 40% or greater,” Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences, told Drug Topics®.³ “It improves kidney outcomes, cardiovascular outcomes, and HF outcomes. So, when you are in the clinic tomorrow, the pharmacy, the hospital, or wherever you are, look for the patient whose eGFR is slowly declining.”

Although CKD is traditionally diagnosed when eGFR falls below 60 mL/min/1.73 m², this threshold often misses the “blind spot” where progressive kidney damage occurs despite a preserved eGFR, particularly when significant albuminuria is present. Because finerenone is a nonsteroidal mineralocorticoid receptor antagonist (nsMRA), it offers a pharmacologically distinct profile from older, steroidal MRAs like spironolactone.^3,4

It binds more selectively to the mineralocorticoid receptor, targeting inflammation and fibrosis in both the heart and kidneys without the high risk of endocrine adverse effects or the prohibitive levels of hyperkalemia often seen with traditional agents. This makes it a suitable fourth pillar of therapy alongside maximally tolerated renin-angiotensin system inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists.^2-4

The Pharmacist’s Role in Managing Finerenone

The clinical impact of pharmacist-led intervention in this space is already becoming evident. A prospective study in socioeconomically deprived populations demonstrated that integrated pharmacist-led clinics could significantly improve key CKD-related outcomes, including eGFR staging and blood pressure control.⁵

These results underscore the evolving role of the diabetology pharmacist, a specialized clinician capable of reducing clinical inertia and navigating the complexities of CKM care. By serving as medication experts who manage collaborative practice agreements, pharmacists can ensure that guideline-directed medical therapies are initiated and optimized before patients reach advanced stages of organ failure, according to Diabetes, Obesity, and CardioMetabolic CARE®.⁶

The goal is to shift the therapeutic focus from symptom management to long-term organ protection. Pharmacists are essential in identifying eligible patients by monitoring the urine albumin-to-creatinine ratio, as a rise in albuminuria is often the earliest warning sign of kidney disease before creatinine levels increase.^2,3

By proactively managing potassium monitoring and addressing residual risk in patients already on standard therapies, pharmacists can change the trajectory of CKM syndrome. This comprehensive approach ensures that patients with T2D and CKD receive a broader shield against the interconnected cycle of cardiovascular and renal events.^2-4

“Look for that patient with normal creatinine but elevated albuminuria. Look for the HF patients cycling through hospitalizations,” concluded Goldman.³ “If we’re only treating glucose and blood pressure in diabetic kidney disease, we are undertreating fibrosis. Finerenone is about protecting organs before they fail.”

READ MORE: Diabetes Resource Center

REFERENCES

1. Lo KB, Ostrominski JW, Hamatani Y, et al. Finerenone across cardiovascular-kidney-metabolic syndrome stages: post hoc analysis of the FIDELITY randomized clinical trials. JAMA Cardiol. June 03, 2026. doi:10.1001/jamacardio.2026.1365

2. Wright E, Frady RB, Uko C. The role of finerenone in optimizing cardiovascular-kidney-metabolic health: everything PCPs should know. Fed Pract. 2024;41(Supplemental 6):S41-S46. https://doi.org/10.12788/fp.0535

3. Nowosielski B, Goldman J, Choi H. Wicked Good Cardiometabolic Chat: the clinical essentials of finerenone. Drug Topics. March 4, 2026. Accessed June 23, 2026. https://www.drugtopics.com/view/wicked-good-cardiometabolic-chat-the-clinical-essentials-of-finerenone

4. Márquez DF, Ortiz A, González-Moreno D. Finerenone: evidence for benefit in early stages of cardiovascular-kidney-metabolic syndrome. Cardiorenal Med. 2025;15(1):619-625. https://doi.org/10.1159/000548494

5. Ramos T, Verma A, Speirits I, et al. Evaluating a pharmacist-led cardio-renal-metabolic service to reduce healthcare inequities in a socioeconomically deprived population: a prospective intervention study. IJCP. 2025;47(5):1395-1405. https://doi.org/10.1007/s11096-025-01938-8

6. Young CF, O’Brien K, Neumiller JJ, et al. The critical role of diabetology pharmacists in improving cardiovascular-kidney-metabolic care and outcomes. Diabetes Obes Cardiometab CARE. 2026;1(1):147-152. https://doi.org/10.2337/doc25-0049