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In any case, it will take more studies to assess the effects in these populations.69,70 Current perspective and recommendations for improvement The 2025 American Diabetes Association (ADA) guidelines advise, with a level of recommendation A, the use of finerenone in patients with T2DM, CKD (eGFR 25 ml/min/1.73 m2) and albuminuria to reduce cardiovascular events and progression of CKD,11 whereas the 2024 Spanish Society of Nephrology consensus for the management of diabetic nephropathy suggests the use of finerenone in patients with T2DM, an eGFR 25 ml/min/1,73 m2, normal serum potassium concentration (5.1 mmol/l) and albuminuria (uACR 30 mg/g), despite the maximum tolerated doses of a RAASi, with a level of recommendation 1A.12 In short, the treatment of patients with CKD and T2DM should follow a comprehensive strategy, which requires a global approach that includes both the control of the different cardiovascular risk factors and the use of those drugs that have demonstrated a benefit at the renal and cardiovascular level, mainly ACEI or ARBs, SGLT2 inhibitors, finerenone and GLP-1 receptor agonists

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Cambridge, United Kingdom: Cambridge University Press

During the dose-escalation period used in clinical trials and expected in clinical practice, each dose level reaches its own steady state before the next escalation step, ensuring that the pharmacokinetic transition between doses is gradual and predictable