Would you recommend starting finerenone for a patient with diabetic kidney disease who has marked improvement from severely increased albuminuria to moderately increased albuminuria following ARB and SGLT2i initiation?

What is your approach to initiating finerenone in a patient with diabetic kidney disease whose albuminuria has improved from severely increased to moderately increased following optimization of ARB and SGLT2 inhibitor therapy?

• I initiate finerenone if potassium and blood pressure allow, regardless of the degree of albuminuria improvement
• I would not initiate finerenone given the improvement in albuminuria, and would continue to monitor on current optimized therapy
• I discuss the potential benefits and risks with the patient, including the possibility of needing potassium binders, and decide jointly
• Other