Objective: To synthesize up-to-date evidence on kidney protection with sodium–glucose cotransporter 2 (SGLT2) inhibitors and the nonsteroidal mineralocorticoid receptor antagonist finerenone in adults with type 2 diabetes (T2D).
Methods: We narratively reviewed randomized controlled trials and practice guidelines published from 2019 to 2025, prioritizing CREDENCE, DAPA-CKD, EMPA-KIDNEY, FIDELIO-DKD, FIGARO-DKD, and ADA/KDIGO recommendations. Outcomes included chronic kidney disease (CKD) progression, kidney failure, albuminuria, and cardiovascular events.
Results: Across diverse CKD phenotypes, SGLT2 inhibitors slowed decline in estimated glomerular filtration rate, reduced composite renal outcomes, and lowered heart failure events, with benefits observed irrespective of baseline atherosclerotic cardiovascular disease. Finerenone, when added to optimized renin–angiotensin system blockade, reduced CKD progression and cardiovascular events in albuminuric T2D-CKD. Current guidelines recommend initiating SGLT2 inhibitors in most patients with T2D and an eGFR ≥20 mL/min/1.73 m². Finerenone should be considered when albuminuria persists despite optimized care and when serum potassium can be monitored.
Conclusions: SGLT2 inhibition provides the therapeutic foundation for renoprotection in T2D-CKD, while finerenone offers complementary anti-inflammatory and antifibrotic benefits. A stepwise, guideline-concordant strategy can slow CKD progression and reduce cardiovascular risk with an acceptable safety profile.