Uso de Dapagliflozina en comparación con el uso de la Finerenona en pacientes con enfermedad renal crónica secundaria a Diabetes mellitus tipo 2

Abstract

Introduction: Chronic kidney disease secondary to type 2 diabetes mellitus represents a major cause of morbidity and mortality worldwide. Dapagliflozin and finerenone are innovative treatments with distinct mechanisms of action that have shown renal and cardiovascular benefits. However, no systematic reviews directly compare their efficacy and safety. Objective: To study the use of dapagliflozin compared to finerenone in patients with chronic kidney disease secondary to type 2 diabetes mellitus through a literature review. Methodology: A literature review was conducted in the PubMed, NIH, ScienceDirect, Google Scholar, UpToDate, and Cochrane Library databases. The review included retrospective and prospective studies, meta-analyses, systematic reviews, and randomized controlled trials conducted in adults (≥18 years) with chronic kidney disease secondary to type 2 diabetes mellitus, published between January 2019 and December 2024 in English or Spanish. Results: Dapagliflozin acts by inhibiting the sodium-glucose cotransporter 2 (SGLT2), promoting glycosuria, reducing glycemia, and providing cardiovascular benefits. Finerenone is a mineralocorticoid receptor antagonist that modulates inflammatory and profibrotic pathways, offering specific renal protection. Dapagliflozin showed an average weight reduction of 2 and 3 kg, attributable to its glucosuric and natriuretic effect. Finerenone does not directly affect body weight but improves systemic inflammation and metabolic markers in specific scenarios. Conclusions: Dapagliflozin and finerenone offer complementary benefits in patients with chronic kidney disease secondary to type 2 diabetes mellitus. Therapeutic decisions should be individualized based on the patient's clinical profile, prioritizing renal, metabolic, and cardiovascular outcomes.