The edition · Nephrology
Starting finerenone and empagliflozin together cut albuminuria regardless of age or sex
A CONFIDENCE analysis found the combination's benefit held across age quartiles and in both sexes. Also: eGFR dips with thiazides in heart failure, who gains most from GLP-1 drugs, and home exercise in advanced CKD.
The edition in brief
An analysis of the CONFIDENCE trial in people with type 2 diabetes and albuminuric CKD found that albuminuria fell more with age (about 10% per decade) and in women (about 19% more than men), but that the added benefit of starting finerenone and empagliflozin together did not differ by age or sex, and safety was consistent. A CLOROTIC trial analysis in acute decompensated heart failure found the eGFR fall with added thiazide (median −14% by day 4) was not associated with mortality or readmission. A Stockholm target trial emulation of 28,500 people with type 2 diabetes found GLP-1 receptor agonists, compared with DPP-4 inhibitors, lowered kidney outcomes overall (HR 0.84), with benefit concentrated in those at highest kidney failure risk. A small Turkish trial in stage 4–5 CKD found a telehealth-supported home exercise programme improved six-minute walk distance by about 49 metres against controls. The pearl covers sick-day guidance.
eGFR dips with added thiazide in heart failure were not linked to worse outcomes
During decongestion with combined loop and thiazide diuretics, a modest eGFR fall need not stop treatment; judge by congestion and electrolytes.
GLP-1 receptor agonists: kidney benefit concentrated in the highest-risk patients
Target GLP-1 receptor agonists for kidney protection at patients with low or falling eGFR and high albuminuria, where absolute benefit is largest.
Home exercise with telehealth support improved function in stage 4–5 CKD
Offer a supported home exercise programme to patients with stage 4–5 CKD to improve function and quality of life.
Sick-day guidance for kidney-relevant drugs
Give every patient on SGLT2 inhibitors, RAS blockers, diuretics or metformin written sick-day instructions.
Start finerenone and empagliflozin together, whatever the patient's age or sex
In type 2 diabetes with albuminuric CKD on RAS blockade, consider starting finerenone and an SGLT2 inhibitor together, regardless of age or sex.
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