- Design
- Subgroup analysis of a randomised trial (CONFIDENCE)
- Population
- Adults with type 2 diabetes, eGFR 30–90 and UACR 100–5000 mg/g on RAS blockade
- Primary outcome
- Change in UACR to day 180 by age and sex
- Effect
- −10.2% per decade of age; women −18.6% vs men; no interaction with combination effect
CONFIDENCE randomised people with type 2 diabetes, CKD (eGFR 30–90) and albuminuria on stable RAS blockade to empagliflozin, finerenone or both started together. The main trial showed combination therapy lowered albuminuria more than either alone at 180 days. This analysis looked at age quartiles and sex.
Older patients had more cardiovascular disease and lower eGFR, but greater albuminuria reduction — about 10% more per decade. Women had about 19% greater reduction than men. Crucially, these effects were independent of treatment: the extra benefit of the combination was the same across age and sex, and safety was consistent.
In practice, the analysis removes a reason to hesitate in older patients or to sequence drugs over months. Starting both together gets albuminuria down sooner. Albuminuria is a surrogate outcome, and potassium needs monitoring with finerenone.
- Consider starting finerenone and an SGLT2 inhibitor together in albuminuric diabetic kidney disease on RAS blockade.
- Do not withhold combination therapy because of older age.
- Check potassium and eGFR within about four weeks of starting finerenone.
- Use albuminuria response to monitor treatment effect.
Why it matters
Sequential add-on over many months delays protection that can start at once.
Don't overread it
This is a subgroup analysis on albuminuria, a surrogate; kidney failure and survival outcomes were not tested here.
The statistics, in plain English
Non-significant interaction P values (0.28 for age, 0.46 for sex) mean the combination's added benefit did not detectably differ across these groups. Age and sex affected albuminuria response regardless of which drugs were given.
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