What role do Ozempic (semaglutide) and Kerendia (finerenone) play in preventing decline in kidney function in patients with type 2 diabetes and chronic kidney disease?

From the Guidelines

Both Ozempic (semaglutide) and Kerendia (finerenone) are effective medications that help prevent kidney function decline in patients with type 2 diabetes and chronic kidney disease, though they work through different mechanisms. Ozempic, a GLP-1 receptor agonist, reduces kidney disease progression by improving glycemic control, promoting weight loss, lowering blood pressure, and reducing inflammation and oxidative stress in the kidneys, as shown in the SUSTAIN-6 trial 1. Kerendia, a non-steroidal mineralocorticoid receptor antagonist, works by blocking the harmful effects of aldosterone on the kidneys, reducing inflammation and fibrosis, as demonstrated in the FIDELIO-DKD and FIGARO-DKD studies 1. For optimal kidney protection, these medications are typically used alongside standard treatments like ACE inhibitors or ARBs, and patients should maintain good blood pressure control (target <130/80 mmHg) and glycemic control (target HbA1c <7%). Some key points to consider when using these medications include:

• Regular monitoring of kidney function (eGFR and urine albumin-to-creatinine ratio) every 3-6 months is essential to track progress.
• When using Kerendia, potassium levels should be monitored due to the risk of hyperkalemia, and the medication should be started only when serum potassium is ≤4.8 mEq/L.
• The selection of specific agents may depend on comorbidity and CKD stage, with SGLT2 inhibitors like empagliflozin and dapagliflozin being more useful for patients at high risk of CKD progression 1. Overall, the use of Ozempic and Kerendia, in conjunction with standard treatments and regular monitoring, can help prevent decline in kidney function in patients with type 2 diabetes and chronic kidney disease, ultimately reducing morbidity, mortality, and improving quality of life.

From the FDA Drug Label

Patients with Renal impairment - Renal impairment does not impact the pharmacokinetics of semaglutide in a clinically relevant manner. The effects of intrinsic factors on the pharmacokinetics of semaglutide are shown in Figure 3. Figure 3 Impact of intrinsic factors on semaglutide exposure Patients with Renal impairment - Renal impairment does not impact the pharmacokinetics of semaglutide in a clinically relevant manner.

The role of Ozempic (semaglutide) in preventing decline in kidney function is not directly stated in the provided drug label. However, it is mentioned that renal impairment does not impact the pharmacokinetics of semaglutide in a clinically relevant manner.

• Key points:
  • Renal impairment does not affect semaglutide pharmacokinetics.
  • The label does not provide direct information on preventing kidney function decline. There is no information about Kerendia (finerenone) in the provided drug label. 2

From the Research

Role of Ozempic (Semaglutide) and Kerendia (Finerenone) in Preventing Decline of Kidney Functions

• Ozempic (semaglutide) and Kerendia (finerenone) are two medications that have been shown to play a significant role in preventing the decline of kidney functions in patients with type 2 diabetes and chronic kidney disease (CKD) 3, 4.
• Semaglutide, a glucagon-like peptide 1 receptor agonist, has been found to reduce the risk of major kidney disease events, including kidney failure, by 24% compared to placebo 3.
• Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, has been shown to reduce the risk of CKD progression and cardiovascular events, including hospitalization for heart failure, when added to maximally tolerated doses of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 4.

Mechanism of Action

• Semaglutide works by reducing glucose levels, improving insulin sensitivity, and decreasing inflammation, which can help to slow the progression of CKD 3, 5.
• Finerenone works by blocking the effects of mineralocorticoids, which can help to reduce fibrosis and inflammation in the kidneys, and improve cardiovascular outcomes 4.

Clinical Evidence

• The FLOW trial demonstrated that semaglutide reduced the risk of major kidney disease events, including kidney failure, by 24% compared to placebo 3.
• The FIDELIO-DKD and FIGARO-DKD trials showed that finerenone reduced the risk of CKD progression and cardiovascular events, including hospitalization for heart failure, by 18% compared to placebo 4.
• The CONFIDENCE trial is currently investigating the effects of dual therapy with finerenone and an SGLT2 inhibitor on kidney outcomes in patients with CKD and type 2 diabetes 6.

Safety and Efficacy

• Semaglutide has been found to be safe and effective in reducing the risk of major kidney disease events, with a low risk of serious adverse events 3, 5.
• Finerenone has also been found to be safe and effective in reducing the risk of CKD progression and cardiovascular events, with a low risk of serious adverse events 4.