Improving Renal Protection in Chronic Kidney Disease Associated with Type 2 Diabetes: The Role of Finerenone

Abstract: Chronic kidney disease (CKD) is a major complication of type 2 diabetes mellitus (T2D), which often leads to diabetic kidney disease (DKD). Traditional therapies, including renin– angiotensin–aldosterone system inhibitors and sodium–glucose cotransporter-2 inhibitors, are effective in slowing CKD progression. However, these approaches are insufficient to comprehensively inhibit mineralocorticoid receptor (MR) overactivation in the kidneys, which remains a significant driver of inflammation, fibrosis, and oxidative stress. These pathological processes accelerate kidney damage and cardiovascular complications. Finerenone—a nonsteroidal mineralocorticoid receptor antagonist—represents a new frontier in renal protection. Unlike steroidal mineralocorticoid antagonists (MRAs), finerenone offers a more selective MR blockade, reducing kidney inflammation and fibrosis without significantly raising serum potassium levels. Landmark trials have demonstrated the ability of finerenone to significantly reduce kidney and cardiovascular events in patients with T2D and CKD. Clinical evidence has highlighted finerenone as an effective option for slowing DKD progression while maintaining a favorable safety profile. Based on these findings, recent guidelines have incorporated finerenone as a recommended therapy for patients with T2D and CKD, emphasizing its role in reducing both renal and cardiovascular risks. This review provides a comprehensive overview of the available data to offer a deeper understanding of the potential of finerenone to transform CKD management for T2D patients.