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Updates on Treatment of Chronic Kidney Disease: Novel Approaches and Future Directions

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Dr. Pietro C. Dattolo

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Guest Editor

Division of Nephrology, Santa Maria Annunziata Hospital, Via Antella 58, 50012 Florence, Italy
Interests: chronic kidney disease; CKD management; health organization in nephrology

Dr. Aris Tsalouchos

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Guest Editor

Division of Nephrology, Santa Maria Annunziata Hospital, Via Antella 58, 50012 Florence, Italy
Interests: chronic kidney disease; clinical nephrology; renal replacement therapy; novel therapeutics in CKD; diagnosis and treatment of glomerular diseases; rare kidney diseases
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Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) remains a major global health challenge, affecting millions of individuals and placing a significant burden on healthcare systems. Advances in relation to its pathophysiological understanding and therapeutic innovations have opened new avenues for CKD management, aiming to slow its progression, improve patient outcomes, and enhance their quality of life.

This Special Issue aims to provide a comprehensive overview of the latest developments in CKD treatment, including novel pharmacological and non-pharmacological interventions, precision medicine approaches, renal replacement strategies, and lifestyle modifications. We welcome original research articles, reviews, and clinical studies that explore emerging therapeutic targets, innovative drug therapies, the role of SGLT2 inhibitors, non-steroidal MRAs, GLP-1 receptor agonists, dietary interventions, personalized treatment strategies, and other drugs currently under investigation in clinical trials.

By gathering cutting-edge research, this Special Issue seeks to foster a deeper understanding of CKD treatment paradigms and pave the way for future advancements in nephrology. We look forward to your valuable contributions to this important field.

Dr. Pietro C. Dattolo
Dr. Aris Tsalouchos
Guest Editors

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Open AccessBrief Report

Real-World Effectiveness of Finerenone Added to SGLT2 Inhibitor and GLP-1 Receptor Agonist Therapy in Individuals with Type 2 Diabetes and Chronic Kidney Disease

by Afif Nakhleh, Khaled Khazim and Naim Shehadeh

J. Clin. Med. 2025, 14(22), 8209; https://doi.org/10.3390/jcm14228209 - 19 Nov 2025

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Abstract

Background/Objectives: Recent randomized controlled trial evidence in adults with type 2 diabetes (T2D) and chronic kidney disease (CKD) indicates that adding finerenone to empagliflozin provides additive clinical benefit. A prespecified analysis demonstrates that this benefit is consistent irrespective of prior glucagon-like peptide-1 receptor agonist (GLP-1 RA) use. We aimed to assess the effectiveness of adding finerenone to existing sodium-glucose cotransporter-2 inhibitor (SGLT2i) and GLP-1 RA therapy in a real-world setting. Methods: We performed a retrospective cohort study of adults with T2D and CKD from Maccabi Healthcare Services diabetes, endocrinology, and nephrology clinics in Haifa, Israel. Included individuals initiated finerenone between 1 August 2023, and 31 January 2025, and met the following criteria: estimated glomerular filtration rate (eGFR) of 25–60 mL/min/1.73 m²; urinary albumin-to-creatinine ratio (UACR) > 300 mg/g; and a history of ≥12 weeks of SGLT2i (empagliflozin or dapagliflozin) and GLP-1 RA (liraglutide, dulaglutide, or semaglutide) use prior to finerenone initiation. Outcomes were assessed at the last measurement taken within 26 ± 10 weeks of finerenone initiation. The primary outcome was adjusted percent change in log-transformed UACR from baseline to follow-up. Secondary outcomes were adjusted mean changes in eGFR and serum potassium. We used multiple linear regression models. Prespecified subgroup analyses examined the UACR change by age, sex, body mass index (BMI), baseline eGFR, and baseline UACR. Results: Fifty-one individuals were included in the study, with a mean age of 66.0 ± 9.5 years and a mean BMI 30.9 ± 5.2 kg/m². The median eGFR was 45 mL/min/1.73 m² (IQR 36–52), and the median UACR was 1001 mg/g (IQR 515–1599). 94% were receiving a renin–angiotensin system inhibitor. Finerenone was initiated at 10 mg/day and titrated to 20 mg/day in eight individuals. Over a median follow-up of 27 weeks, the adjusted percent change in UACR was −51.3% (p < 0.001), consistent across prespecified subgroups. The adjusted mean eGFR change was −3.92 mL/min/1.73 m² (p < 0.001). Serum potassium increased by +0.34 mmol/L (p < 0.001). Conclusions: In adults with T2D and albuminuric CKD already receiving an SGLT2i and a GLP-1 RA, adding finerenone substantially reduced albuminuria. Full article

(This article belongs to the Special Issue Updates on Treatment of Chronic Kidney Disease: Novel Approaches and Future Directions)

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