Complementary Effects of Finerenone and Dapagliflozin on Renal Outcomes in Patients with Diabetic Nephropathy: a Prospective Observational Comparative Study

Abstract

Background: Diabetes Mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia and is a major contributor to microvascular complications, particularly diabetic nephropathy. Diabetic Nephropathy is a leading cause of Chronic Kidney Disease (CKD) and end-stage renal disease worldwide. Risk factors such as poor glycemic control, hypertension, obesity, and prolonged duration of diabetes accelerate renal damage. Early assessment of renal and metabolic parameters is essential to prevent disease progression and improve patient outcomes.

Objectives: To assess the Complementary effects of Finerenone and Dapagliflozin on renal outcomes in patients with Diabetic Nephropathy visiting a tertiary care teaching hospital.

Materials and Methods: A prospective observational comparative study was conducted among 368 adult patients diagnosed with diabetic nephropathy attending the Department of Nephrology at a tertiary care teaching hospital. Participants were allocated into two treatment groups according to routine clinical practice: patients receiving dapagliflozin alone and those receiving combined finerenone plus dapagliflozin therapy. Baseline demographic characteristics, clinical parameters, laboratory investigations, estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), glycated haemoglobin (HbA1c), serum creatinine, and serum potassium were recorded and monitored throughout the study period. Statistical analyses were performed using appropriate parametric and non-parametric tests, with a p-value < 0.05 considered statistically significant.

Results: The combination therapy group demonstrated greater improvement in renal outcomes compared with dapagliflozin monotherapy. Patients receiving finerenone in addition to dapagliflozin showed a larger reduction in albuminuria and better preservation of eGFR during follow-up. Improvements in glycaemic control and blood pressure were also observed without clinically significant increases in adverse renal events. Hyperkalaemia occurred infrequently and was managed conservatively. Overall, combination therapy was associated with favourable renal and metabolic outcomes compared with monotherapy.

Conclusion: The complementary use of finerenone and dapagliflozin appears to provide enhanced renoprotective benefits in patients with diabetic nephropathy by reducing albuminuria and slowing renal function decline while maintaining an acceptable safety profile. These findings support the potential role of combination therapy in the management of diabetic kidney disease. Larger multicentre randomized controlled trials with longer follow-up are warranted to confirm these observations.