I use the same approach investigators did in the Fidelio DKD study: patient on max dose of ACEi/ARB. Add finerenone--> check GFR in 4 weeks. If more than 30% drop hold any NS-MRA up titration and recheck GFR in 1 week. If stable, continue same drug regimen, if GFR further decreases, hold finereno...

I usually tolerate quite a bit of a decline in eGFR after starting ACE/ARB, SGLT-2, finerenone and diuretics. This is especially true if the blood pressure is better controlled and the degree of albuminuria is lower. Each patient is different. If the eGFR is very low and one can buy dialysis free ti...