Finerenone (Fn), is a non-steroidal selective mineralocorticoid receptor antagonist (MRA), that induces less hyper-k+but may possess other beneficial
: SGLT2i: added to the general measures + ACEi/ARB in albuminuric ptns, Na+-glucose co-transporter 2 inhibitors (SGLT2i) has been suggested:
o SGLT2i: addition to ptns therapy with SGLT2i. SGLT2i therapy should be generally avoided among ptns with eGFR < mL/min/1.73 m2 despite they can be given safely with eGFR < 25 mL/min/1.73 m2. These agents should be used cautiously with previous LL amputation or possibility of amputation (e.g., LL ulcer & PVD). If canagliflozin (Invokana) is given, target dose is 100 mg once/d. Initial dose of other SGLT2i (e.g., 10 mg once/d of dapagliflozin (Forxiga) or empagliflozin 10 mg once/d.) are accepted therapy for DKD in type 2 DM.
o SGLT2i can impede important renal endpoints e.g., ESKD. Despite the risk decline of RF is the same with/without highly elevated albuminuria (urinary albumin ≥300 mg/d), absolute risk decline is with severely elevated albuminuria. So, current recommendations are stronger for SGLT2i use with severely elevated albuminuria than normo-albuminuric ptns or moderately elevated albuminuria.
Contraindications & precautions: DO 👆NOT use SGLT2i with the following: