Jose A, Kamrul-Hasan ABM, Fernandez CJ, Pappachan JM. Efficacy of finerenone in reducing proteinuria in diabetic kidney disease on dapagliflozin and telmisartan: A disease-modifying approach. World J Nephrol 2026; 15(3): 120295 [DOI: 10.5527/wjn.120295]
Corresponding Author of This Article
Joseph M Pappachan, MD, MRCP, FRCP, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, Ormond Building, Manchester M15 6BH, United Kingdom. drpappachan@yahoo.co.in
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Endocrinology & Metabolism
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review-article
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Jose A, Kamrul-Hasan ABM, Fernandez CJ, Pappachan JM. Efficacy of finerenone in reducing proteinuria in diabetic kidney disease on dapagliflozin and telmisartan: A disease-modifying approach. World J Nephrol 2026; 15(3): 120295 [DOI: 10.5527/wjn.120295]
World J Nephrol. Sep 25, 2026; 15(3): 120295 Published online Sep 25, 2026. doi: 10.5527/wjn.120295
Efficacy of finerenone in reducing proteinuria in diabetic kidney disease on dapagliflozin and telmisartan: A disease-modifying approach
Antresa Jose, Abul Bashar Mohammad Kamrul-Hasan, Cornelius J Fernandez, Joseph M Pappachan
Antresa Jose, Department of Endocrinology, Mar Sleeva Medicity Pala 686584, Kerala, India
Abul Bashar Mohammad Kamrul-Hasan, Department of Endocrinology, Mymensingh Medical College, Mymensingh 2200, Bangladesh
Cornelius J Fernandez, Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, Lincolnshire, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, Greater Manchester, United Kingdom
Joseph M Pappachan, Department of Endocrinology and Metabolism, Countess of Chester Hospital NHS Trust, Chester CH2 1UL, Cheshire West and Chester, United Kingdom
Joseph M Pappachan, Department of Endocrinology and Metabolism, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
Author contributions: Jose A and Kamrul Hasan ABM substantially contributed to article drafting after performing literature search and interpretation of the data to make the initial draft with guidance from Fernandez CJ and Pappachan JM; Fernandez CJ created the figures with guidance from Pappachan JM who contributed to the conceptualization and design of the article, and overall supervision of the whole article drafting process; all authors contributed to revision and have read and approved the final version of the manuscript.
Conflict-of-interest statement: Authors have no conflicts to declare in relation to this article.
Corresponding author: Joseph M Pappachan, MD, MRCP, FRCP, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, Ormond Building, Manchester M15 6BH, United Kingdom. drpappachan@yahoo.co.in
Received: February 24, 2026 Revised: March 5, 2026 Accepted: April 21, 2026 Published online: September 25, 2026 Processing time: 171 Days and 21.2 Hours
Abstract
With the alarming rise in the global prevalence of the disease, type 2 diabetes mellitus (T2DM) has recently become the leading cause of chronic kidney disease (CKD) worldwide. Proteinuria, the earliest and common indicator of diabetic kidney disease (DKD), not only increases the risk of progression of CKD to end-stage renal disease (ESRD) but also multiplies the risk of cardiovascular (CV) disease in patients with diabetes. Medications such as angiotensin-converting enzyme inhibitors (ACEis), angiotensin II receptor blockers (ARBs), sodium-glucose cotransporter-2 inhibitors (SGLT-2is), and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce proteinuria and therefore possess disease-modifying properties in patients with DKD. Clinical trials have demonstrated the efficacy of finerenone, a highly selective, non-steroidal MRA, in reducing renal and CV outcomes in patients with long-standing T2DM. The benefits of various SGLT-2is have also been observed in multiple studies. Therefore, a combination of these medications, with independent but complementary mechanisms of action, could provide superior benefits as add-on therapies to ACEis/ARBs rather than using either alone. This Opinion Review explores disease-modifying strategies in patients with DKD based on the most up-to-date evidence.
Core Tip: Diabetic kidney disease (DKD) is a leading cause of morbidity and mortality in people with diabetes mellitus. Traditional disease-modifying treatments do not fully target the underlying mechanisms. The renin-angiotensin-aldosterone system is over activated and only partially suppressed by the renin-angiotensin-aldosterone system blockers like angiotensin- converting enzyme inhibitors or angiotensin II receptor blockers in the context of DKD. This article is based on the latest research evidence and discusses the relevant strategies for treating diabetic nephropathy patients.
