A new clinical trial offers hope for millions of people with chronic kidney disease (CKD) and type 2 diabetes, showing that a combination of two drugs—finerenone and empagliflozin—can significantly reduce kidney damage when administered together.

Published in the New England Journal of Medicine and presented at the European Renal Association’s annual meeting in Vienna, the study reveals that patients receiving the drug combination experienced a 52% reduction in their urinary albumin-to-creatinine ratio (UACR)—a key marker of kidney damage. In comparison, patients taking finerenone or empagliflozin alone showed UACR reductions of 29% and 32%, respectively.

“These results were significantly greater than with either treatment alone,” said lead author Dr. Rajiv Agarwal, Professor Emeritus at the Indiana University School of Medicine. “In other chronic conditions like heart failure or hypertension, we’re moving away from the traditional stepwise approach toward upfront combination therapy. This could be a similar game-changer in the management of kidney disease.”

Understanding the Drug Combination

Finerenone, marketed as Kerendia, is a non-steroidal mineralocorticoid receptor antagonist that targets inflammation and fibrosis in the kidneys. Empagliflozin, sold as Jardiance, is an SGLT2 inhibitor commonly used in diabetes care to lower blood sugar by promoting glucose excretion through urine. Both drugs are already approved individually, but this trial is the first to comprehensively assess their combined impact on CKD progression.

The Clinical Trial

The study enrolled 818 participants with both CKD and type 2 diabetes—conditions that together significantly raise the risk of cardiovascular disease and kidney failure. Patients were randomly assigned to receive either drug alone or both in combination for six months.

Results showed that 70% of those in the combination group achieved a UACR reduction of more than 30%—a benchmark recommended by the American Diabetes Association for reducing kidney and cardiovascular risk.

“Since UACR is a key mediator of kidney and cardiovascular outcomes, these results are highly relevant for clinical decision-making,” Dr. Agarwal noted.

Implications for Clinical Practice

The findings could signal a shift in how doctors treat CKD in diabetic patients. Rather than a step-by-step approach, where one drug is added after another fails, clinicians might consider initiating both therapies simultaneously to achieve faster and more effective kidney protection.

With the rising burden of diabetes-related kidney disease worldwide, this study could pave the way for improved patient outcomes and reduced healthcare costs.

As the global medical community continues to search for ways to combat chronic conditions with high mortality and morbidity, this combination therapy stands out as a promising advancement in nephrology and endocrinology alike.