Impact of Baseline GLP-1 Receptor Agonist Use on Albuminuria Reduction and Safety With Simultaneous Initiation of Finerenone and Empagliflozin in Type 2 Diabetes and Chronic Kidney Disease (CONFIDENCE Trial)
Authors' conclusion
In CONFIDENCE, simultaneous initiation with finerenone and an SGLT2 inhibitor was effective and well tolerated compared with monotherapy, irrespective of background use of a GLP-1 RA.
Study context
- Population
- Adults with CKD (urinary albumin-to-creatinine ratio (UACR) ≥100 to <5,000 mg/g; eGFR 30–90 mL/min/1.73 m²) and T2D (HbA1c <11% [97 mmol/mol]); 182 (23%) used a GLP-1 RA at baseline182 on GLP-1 RA
- Participants
- 800 adults
- Comparison
- Finerenone plus empagliflozin vs finerenone vs empagliflozin, by baseline GLP-1 RA use
- Primary endpoint
- UACR change from baseline, by baseline GLP-1 RA use
- Follow-up
- Day 180
Methodological detailsprespecified analysis, randomized 1:1:1
- Prespecified analysis
- Randomized 1:1:1
Primary result
As reported in the abstract
Combination therapy (GLP-1 RA use)
−51%
95% CI −59–-40%
Finerenone (GLP-1 RA use)
−34%
95% CI −48–-18%
Empagliflozin (GLP-1 RA use)
−36%
95% CI −48–-21%
Combination therapy (no GLP-1 RA)
−56%
95% CI −62–-50%
Finerenone (no GLP-1 RA)
−37%
95% CI −45–-28%
Empagliflozin (no GLP-1 RA)
−33%
95% CI −41–-23%
Further findings
- Decreases in systolic blood pressure observed, more pronounced with combination therapy
Safety
Hyperkalemia incidence with combination therapy, by baseline GLP-1 RA use
Other safety
- eGFR changes consistent with and without baseline GLP-1 RA use
- Acute kidney injury was uncommon
- Decreases in systolic BP observed, more pronounced with combination therapy
Original publication
Impact of Baseline GLP-1 Receptor Agonist Use on Albuminuria Reduction and Safety With Simultaneous Initiation of Finerenone and Empagliflozin in Type 2 Diabetes and Chronic Kidney Disease (CONFIDENCE Trial). Diabetes Care. Published 19 September 2025. doi:10.
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