Finerenone in Asian Patients with Type 2 Diabetes Mellitus and Albuminuric Chronic Kidney Disease: From Evidence to Implementation

Finerenone reduces kidney and cardiovascular risk in patients with type 2 diabetes mellitus (T2DM) and albuminuric chronic kidney disease (CKD). Recent Asian subgroup, pooled, combination-therapy, Asian versus non-Asian, and real-world analyses have expanded the evidence base relevant to Asian practice. These data support the consistency of finerenone efficacy and safety in Asian patients and do not support withholding treatment on the basis of Asian ethnicity alone. However, the central question in Asia is shifting from whether finerenone is effective to how eligible patients can be identified, treated, monitored, and continued on therapy in routine care. This review summarizes Asian evidence from the FIDELIO-DKD, FIGARO-DKD, FIDELITY, and CONFIDENCE programs and emerging Asian real-world data. Focus is placed on persistent albuminuric risk, potassium monitoring, treatment sequencing with sodium-glucose cotransporter 2 inhibitors, and implementation feasibility across heterogeneous health-care systems. Finerenone should be considered an evidence-based add-on therapy when baseline potassium and kidney function are appropriate and early laboratory monitoring can be delivered. Simultaneous or early combination therapy may be appropriate in selected high-risk patients, but is not a universal default strategy. The practical priority is to strengthen CKD phenotyping, albuminuria testing, structured potassium monitoring, and care pathways that support sustained use of trial-proven therapy.