Simultaneous initiation of finerenone and empagliflozin across the spectrum of kidney risk in the CONFIDENCE trial

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Overview

Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Double Diabetes Meds Combo Better Than Going Solo for Kidney Trouble

A study of patients with type 2 diabetes and chronic kidney disease found that taking finerenone and empagliflozin together worked better than either drug alone for reducing a key marker of kidney damage (UACR). The benefits were seen across a range of kidney disease severity, but the study only lasted six months, so longer-term outcomes are unknown. The study was sponsored by the company that makes finerenone, and multiple authors reported ties to pharmaceutical companies.

Possible Conflicts of Interest

The study was funded by Bayer AG, the manufacturer of finerenone. Several authors disclosed financial ties to pharmaceutical companies, including Bayer, that manufacture diabetes and kidney medications. While the authors state that they designed the trial and analyzed the data independently, the funding source and industry ties represent a potential conflict of interest.

Identified Weaknesses

Short follow-up duration

The study only lasted 6 months, which is a short time frame for kidney disease progression.

Uneven distribution of KDIGO risk categories

While the trial included patients across a range of kidney function, the majority had high or very high risk of kidney failure, making it harder to generalize the findings to everyone with diabetic kidney disease.

Stringent inclusion/exclusion criteria

The study used very specific criteria for enrolling patients, which might not reflect real-world practice.

Rating Explanation

This is a well-designed study with a large sample size that addresses an important clinical question. The findings are promising for the treatment of diabetic kidney disease. However, the short follow-up duration and the specific patient population limit the generalizability of the findings slightly, hence the rating of 4 instead of 5.

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