From the Guidelines
Kerendia (finerenone) should be initiated in patients with chronic kidney disease (CKD) and type 2 diabetes who have an estimated glomerular filtration rate (eGFR) of 25-60 mL/min/1.73m² and albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g), while already receiving standard of care therapy including maximum tolerated doses of ACE inhibitors or ARBs. This recommendation is based on the FIDELIO trial, which reported that treatment with finerenone resulted in lower risks for CKD progression and cardiovascular events in patients with CKD and type 2 diabetes already on RAS blockade 1.
Key Considerations for Initiating Kerendia
- Patients should have a serum potassium level ≤4.8 mEq/L before starting Kerendia
- Patients should not be taking strong CYP3A4 inhibitors
- The typical starting dose is 10 mg once daily for patients with eGFR ≥60 mL/min/1.73m², and 10 mg every other day for those with eGFR 25-60 mL/min/1.73m²
- Serum potassium should be monitored 4 weeks after initiation and periodically thereafter, with dose adjustments made based on potassium levels
Mechanism of Action and Benefits
Kerendia works as a non-steroidal, selective mineralocorticoid receptor antagonist that reduces inflammation and fibrosis in the kidneys, providing kidney protection beyond what ACE inhibitors or ARBs can offer alone. This medication helps slow CKD progression and reduces cardiovascular risk in this high-risk population. The use of Kerendia is supported by the 2020 KDIGO clinical practice guideline, which emphasizes the importance of RAS inhibitors in slowing the progression of kidney disease in persons with albuminuria and hypertension 1.
Monitoring and Dose Adjustments
Regular monitoring of serum potassium levels is crucial to minimize the risk of hyperkalemia, and dose adjustments should be made accordingly. Additionally, patients should be closely monitored for signs of kidney disease progression and cardiovascular events. By initiating Kerendia in patients with CKD and type 2 diabetes who meet the specified criteria, healthcare providers can help reduce the risk of CKD progression and cardiovascular events, ultimately improving patient outcomes.
From the Research
Indications for Kerendia (Finerenone) Initiation
Kerendia (finerenone) is indicated for the treatment of chronic kidney disease (CKD) with albuminuria in adult patients with type 2 diabetes (T2D) 2. The initiation of Kerendia should be considered in patients with CKD and T2D who are at risk of progression to end-stage CKD or cardiovascular events.
Patient Selection
The decision to initiate Kerendia should be based on individual patient characteristics, including:
- Presence of albuminuria
- Level of glomerular filtration rate (GFR)
- Presence of cardiovascular risk factors
- Concomitant medications, including renin-angiotensin system inhibitors (RASi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i)
Monitoring and Safety Considerations
Patients initiated on Kerendia should be monitored for:
- Serum potassium levels, as finerenone can increase the risk of hyperkalemia 2, 3
- Renal function, including GFR and albuminuria
- Cardiovascular events, including hospitalization for heart failure
Combination Therapy
Kerendia can be used in combination with other medications, including RASi and SGLT2i, to achieve optimal cardiorenal benefits 4, 5, 6. The combination of finerenone and empagliflozin has been shown to lead to a greater reduction in urinary albumin-to-creatinine ratio than either treatment alone 6.
Key Considerations
- Kerendia is indicated for the treatment of CKD with albuminuria in adult patients with T2D
- Patient selection should be based on individual characteristics, including presence of albuminuria and cardiovascular risk factors
- Monitoring and safety considerations, including serum potassium levels and renal function, are crucial when initiating Kerendia
- Combination therapy with other medications, including RASi and SGLT2i, can achieve optimal cardiorenal benefits.