From the Guidelines
Kerendia (finerenone) should be considered as a treatment option for patients with type 2 diabetes and chronic kidney disease to reduce cardiovascular mortality and morbidity, as evidenced by the FIGARO-DKD study 1. The medication is typically prescribed at a starting dose of 10 mg or 20 mg once daily, depending on kidney function, with the possibility of dose increase after 1 month if serum potassium levels are stable and within the normal range.
- The primary benefits of Kerendia include a 13% reduction in the primary composite outcome of cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure, as well as a reduction in end-stage kidney disease 1.
- Common side effects of Kerendia include hyperkalemia, which occurred in 10.8% of patients in the FIGARO-DKD study, although only 1.2% of patients discontinued the medication due to this side effect 1.
- Patients taking Kerendia should have regular blood tests to monitor kidney function and potassium levels, and the medication should not be taken with strong CYP3A4 inhibitors, with dosage adjustments potentially needed when taken with moderate CYP3A4 inhibitors.
- The use of Kerendia has the potential to slow disease progression and reduce the risk of cardiovascular complications in patients with type 2 diabetes and chronic kidney disease, making it a valuable addition to standard treatments like ACE inhibitors or ARBs 1.
From the Research
Kerendia Overview
- Kerendia, also known as finerenone, is a nonsteroidal mineralocorticoid receptor antagonist used in the treatment of chronic kidney disease (CKD) with albuminuria in adult patients with type 2 diabetes (T2D) 2.
- It has been shown to reduce the risk of kidney and cardiovascular events in patients with CKD and T2D, with a favorable benefit-risk profile 3.
Efficacy and Safety
- Finerenone has been associated with significant reductions in kidney- and CV-related endpoints compared with placebo, with minimal effects on serum potassium and kidney function in phase III trials 3.
- The safety profile of finerenone is excellent, but it can cause an increase in serum potassium levels, which requires caution and monitoring 2.
- Finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2D, and risks appear consistent irrespective of HbA1c levels or insulin use 4.
Combination Therapy
- The CONFIDENCE study is investigating whether dual therapy with finerenone and an SGLT2i is superior to either agent alone in reducing albuminuria in patients with CKD and T2D 5.
- Finerenone has been shown to be effective in reducing cardiorenal outcomes in patients with CKD and T2D, irrespective of SGLT2i use 6.
- The benefits of finerenone compared with placebo on cardiorenal outcomes in patients with CKD and T2D were observed irrespective of SGLT2i use 6.
Patient Selection and Monitoring
- Finerenone is indicated in the treatment of CKD with albuminuria in adult patients with T2D, and it is reimbursed with conditions in combination with a renin-angiotensin blocker in Belgium 2.
- The risk of hyperkalemia requires some caution regarding both patient selection and monitoring, especially in patients with higher serum potassium levels 2.