FF 83 CONFIDENCE: Can We Start Flozins and Finerenone Simultaneously?

The Filtrate

Joel Topf @kidneyboy.bsky.social‬

Swapnil Hiremath @hswapnil.medsky.social

Nayan Arora captainchloride.bsky.social

Sopia Ambruso @sophia-kidney.bsky.social

Special Guests

Brendon Neuen @brendonneuen.bsky.social Associate Professor and Program Lead, Renal and Metabolic at The George Institute for Global Health. Nephrologist and Director of Kidney Trials at Royal North Shore Hospital.

Neuen has had three prior appearances on Freely Filtered: EMPA Kidney, DUPLEX and Sparsentan in FSGS, FLOW and Semaglutide

Muthiah Vaduganathan @mvaduganathan on X. Cardiologist at Brigham and Women's Hospital and Harvard Medical School. Assistant Professor of Medicine.

Editing by

Joel Topf

The Kidney Connection written and performed by Tim Yau

Show Notes

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Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes NEJM | NephJC Summary

FIDELIO Bakris et al, NEJM 2020 | NephJC Summary; subgroup throws doubt on efficacy of finerenone in patients on flozins

FIGARO Pitt et al, NEJM 2021; subgroups clearly shows finerenone works, flozins or not

NEJM editorial (wrongly) saying do not use Flozins unless on RASi 

Don’t use dual RAS blockade ONTARGET Yusuf et al, NEJM 2008; VA NEPHRON-D Fried et al NEJM 2013

Why we cannot study finerenone in HFrEF (RALES Pitt et al NEJM 1999) 

Muthu is jealous of GFR slope and albuminuria surrogate endpoints and wants to borrow them for HFpEF (Inker et al EHJ 2025)

Combination therapy and CV outcomes in hypertension (Wang et al JAMA Card 2024 on low dose combinations and BP; Egan et al Blood Pressure 2022 review of topic) 

CONFIRMATION HF trial registry entry (Finerenone and Empagliflozin in hospitalized patients with HF)

23:20: Nayan and Swap miss a chance to say ‘de-flozination’ to discuss stopping a flozin which would allow a patient to be included in the trial 

Finerenone is a CYP3A4 substrate (Heinig et al Clin Pharmacokinetics 2023); Useful list of CYP3A4 inducers and inhibitors 

Everyone should get an ABPM (Bugeja et al CMAJ 2022)

EASiKIDNEY study design 

Albuminuria mediates CKD benefits with Finerenone (Agarwal et al Ann Intern Med 2023)

GFR slope and Albuminuria and the FDA (Taylor et al eClin Med 2025) 

Dapagliflozin and Eplerenone combination crossover trial (Provenzano et al JASN 2022)

Joel gets promoted! (PBFluids reflection) 

Bluesky NephJC Chat discussion on ‘renal remission’ 

Withdrawal of Finerenone and worse outcomes from FINEARTS (Vaduganathan et al JACC 2025)

Combination therapies Analysis from Brendan and Muthu (Neuen et al Circulation 2024)

Do not use KFRE when GFR > 60 (KDIGO Practice Point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2) 

Finerenone vs Spironolactone trial in Primary Aldosteronism (Hu et al Circulation 2025)

FIND CKD trial design (Heerspink et al NDT 2025) 

FINE-ONE trial design (Heerspink et al Diab Res Practice 2023) 

Tubular Secretions

Nayan keeping his chin up as Yankees lose and Mariners follow (MLB Playoffs)

Sophia’s adventures with Beekeeping (Royal Jelly?) 

Brendon loves listening to ‘Susan’ by Raye 

Muthu is back into Taekwondo 

Swap is still reading Martha Wells (Witch King on GoodReads)

Joel will be hiking the Laugavegur trail in Iceland