Two Is Better Than One: Study Backs Early Combo for Kidney and Heart Health in Diabetes

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Results of a new global study show that starting two diabetes-related medications at the same time may offer better protection for the kidneys — and it’s just as safe as taking them separately.

The results come from the CONFIDENCE trial, which looked at people living with chronic kidney disease (CKD) and Type 2 diabetes. These two conditions often go hand-in-hand and raise the risk of serious health problems, including heart disease and kidney failure.

Researchers studied two medications:

• Finerenone (brand name Kerendia)
• Empagliflozin (brand name Jardiance)

Both are already approved to help protect the kidneys and heart in people with Type 2 diabetes. But this is the first major trial to test what happens when patients start both at the same time.

What the Study Found

The CONFIDENCE trial included 800 patients from 14 countries. It was presented at the 2025 European Renal Association Congress, one of the top medical meetings focused on kidney health.

Patients were randomly chosen to take either medication alone or start taking both together. The primary outcome of interest for the investigators was the change in a key marker for kidney damage called the urinary albumin-to-creatinine ratio (UACR).

Patients who took both medications together had a 52% drop in UACR, which was a much stronger result than what was seen in people who took just one of the medications:

• 29% better than finerenone alone
• 32% better than empagliflozin alone

Researchers say this early and combined approach could help slow down kidney disease faster and provide better protection for the heart too.

“This study gives strong clinical evidence that starting these two drugs together has a clear benefit,” said Rajiv Agarwal, M.D., one of the lead researchers, who is professor emeritus of medicine, Indiana University School of Medicine, and is affiliated with the VA Medical Center in Indianapolis. “It’s a big step forward in managing kidney disease in people with diabetes.”

Safe and Well Tolerated

Some patients worry about the risks of taking multiple medications. But the study showed that using both drugs at the same time was well tolerated:

• Less than 5% of patients stopped treatment due to side effects.
• Serious side effects were rare and similar across all groups.
• The most common concern, high potassium levels, was very uncommon.

Researchers checked in with patients even after they stopped taking the medicine and saw that UACR levels rose again — showing that the medicine’s effects were real and meaningful.

Why This Matters

In the past, doctors often added one medication at a time when treating CKD and diabetes. But now, a growing number of experts support a “pillared approach” — starting multiple, proven medications early to slow the disease more effectively.

This new study supports that strategy.

“We now have four proven medication types for CKD in diabetes. This study helps confirm that using more than one — starting early and together — can give patients better results,” said Michael Devoy of Bayer, one of the study sponsors.

What Patients Should Know

If you have Type 2 diabetes and kidney disease, talk to your doctor about all your treatment options. This study suggests that starting combination therapy earlier could improve your health and protect your kidneys and heart over time.

Always follow your doctor’s advice and ask questions if you’re unsure about your medications. With the right plan, many people with CKD and Type 2 diabetes can manage their condition and prevent serious complications.