A 65-year-old woman with type 2 diabetes, heart failure with reduced ejection fraction (LVEF 32%), and eGFR 38 mL/min/1.73m² is currently on metformin, a SGLT2 inhibitor, and insulin. Which medication provides DUAL benefit — reducing HF hospitalization AND slowing CKD progression — in this patient?

• A GLP-1 receptor agonist (semaglutide)
• B SGLT2 inhibitor (she is already on this — continue and optimize)
• C Linagliptin
• D Finerenone (non-steroidal MRA) ✓

Explanation

Finerenone, a non-steroidal selective mineralocorticoid receptor antagonist (MRA), reduces both HF hospitalization and CKD progression in diabetic kidney disease (FIDELIO-DKD and FIGARO-DKD trials). Unlike spironolactone/eplerenone, finerenone has lower risk of gynecomastia and hyperkalemia and can be used at eGFR ≥25 mL/min. SGLT2 inhibitors also provide both HF and renal protection, but since she is already on one, finerenone represents the add-on benefit per FLOW and FIDELITY analyses. GLP-1 RA provides renal benefit mainly by reducing proteinuria, with HF benefit less well established.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.