Would you consider using finerenone for proteinuric CKD associated with type 1 diabetes mellitus?

Yes, although T1DM is off-label for finerenone and there may be issues regarding its approval by prescription drug plans. I would start with an ACEi/ARB for proteinuria in a T1DM patient, then add spironolactone. If the patient develops breast problems on spironolactone, I would switch to eplerenone...

In a normotensive patient with proteinuria after the use of ACE/ARB, would add finrenone.

In a hypertensive patient with proteinuria, would add spironolactone.

I would use finereone in type 1 diabetic patients with stages of CKD 1-3. It reverses the fibrosis that aldosterone produces in the kidneys causing progression of a diabetics CKD.

As finereone has a lower incidence of hyerkalemia, due to its being a non-sterodial MRA, if hyperkalmemia develops, the ...