In patients with type 2 diabetes and albuminuric CKD already on ACEi/ARB, are you initiating finerenone over spironolactone in the primary care setting?

An estimated glomerular filtration rate (eGFR) ≥ 25 mL/min/1.73 m² is typically required to initiate finerenone, though existing SGLT2 inhibitor therapy can be safely continued even if eGFR falls below 20 mL/min/1.73 m².

For a patient with T2D and albuminuric CKD already on ACEi/ARB, the practical t...

There is a lot of activity in this space. Beyond ACE/ARB, I would opt for SGLT2i over mineralocorticoid receptor antagonist (MRA) or non-steroidal mineral corticoid antagonist (NSMA) given the benefit for cardiovascular disease outcome in addition to CKD. The major question is, “What about GLP-1s?”