From the Guidelines
Kerendia (finerenone) should be considered as a treatment option for patients with type 2 diabetes and chronic kidney disease to reduce the risk of cardiovascular events and slow kidney disease progression, as evidenced by the FIGARO-DKD study 1. The typical starting dose of Kerendia is 10 mg or 20 mg once daily, depending on kidney function, with the dose selected based on estimated glomerular filtration rate (eGFR) 1. Key benefits of Kerendia include:
- Reduction in cardiovascular events, including cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure, with a 13% reduction in the primary endpoint 1
- Reduction in end-stage kidney disease, with a hazard ratio of 0.64 1
- Unique mechanism of action as a non-steroidal, selective mineralocorticoid receptor antagonist, which blocks the harmful effects of aldosterone and reduces inflammation and fibrosis in the kidneys and heart Common side effects of Kerendia include hyperkalemia, which requires regular monitoring of potassium levels, especially when starting treatment 1. Important considerations for patients taking Kerendia include:
- Taking the medication at the same time each day with food
- Avoiding consumption of grapefruit or grapefruit juice, as it may affect drug levels
- Avoiding use with strong CYP3A4 inhibitors and potentially adjusting the dose when used with moderate CYP3A4 inhibitors Overall, Kerendia represents an important addition to the treatment arsenal for diabetic kidney disease, offering a unique mechanism of action and benefits in reducing cardiovascular events and slowing kidney disease progression 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, 3.
- It has been shown to reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage renal disease (ESRD), cardiovascular death, nonfatal myocardial infarction (MI), and hospitalization for heart failure in adults with CKD associated with T2D 3.
Clinical Trials and Efficacy
- The FIDELIO-DKD and FIGARO-DKD clinical trials demonstrated that finerenone significantly reduced the primary composite renal and cardiovascular outcomes in patients with T2D and CKD 2, 4.
- A pooled analysis of these trials, known as the FIDELITY analysis, showed that finerenone reduced the risk of kidney and cardiovascular events, with a hazard ratio of 0.86 for the cardiovascular outcome and 0.77 for the renal outcome 2.
- The use of finerenone in combination with sodium-glucose cotransporter 2 inhibitors (SGLT2is) did not affect its efficacy in reducing cardiorenal outcomes 4.
Safety Profile and Side Effects
- Finerenone has been associated with a significant increase in serum potassium levels, although this increase is less pronounced than that seen with spironolactone 2, 5.
- The risk of hyperkalemia requires caution regarding patient selection and monitoring, particularly in patients with declining renal function 6.
- The use of a new oral potassium adsorbent may help prevent hyperkalemia and allow for the continuation of finerenone treatment 6.
Comparison with Other Mineralocorticoid Receptor Antagonists
- Finerenone has a favorable benefit-risk profile compared to older steroidal mineralocorticoid receptor antagonists such as spironolactone and eplerenone 5.
- Nonsteroidal mineralocorticoid receptor antagonists like finerenone have a different mechanism of action and affinity for epithelial and non-epithelial tissues compared to steroidal antagonists 6.