From the Guidelines
Finerenone should be added to the treatment regimen of patients with diabetic kidney disease (DKD) to reduce the risk of kidney disease progression and cardiovascular events, as it has been shown to decrease the composite risk of kidney failure, sustained decrease in eGFR, and renal death, while also decreasing the risk of cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure 1. The clinical rationale for adding finerenone to the treatment regimen of patients with DKD is based on its mechanism of action as a non-steroidal, selective mineralocorticoid receptor antagonist, which blocks the harmful effects of aldosterone, contributing to inflammation and fibrosis in both the kidneys and heart.
- Finerenone is typically prescribed at an initial dose of 10 mg or 20 mg once daily, depending on the patient's estimated glomerular filtration rate (eGFR), with the lower dose used for those with more reduced kidney function.
- It is specifically indicated for patients with chronic kidney disease associated with type 2 diabetes who have albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and an eGFR of 25-60 ml/min/1.73m².
- Finerenone provides complementary benefits when added to standard therapies like SGLT2 inhibitors and ACE inhibitors/ARBs.
- Clinicians should monitor potassium levels before starting treatment and periodically thereafter, as hyperkalemia is a potential side effect, with a higher incidence of hyperkalemia observed in patients treated with finerenone compared to placebo 1.
- The medication should not be initiated if serum potassium is >5.0 mEq/L and should be temporarily discontinued if levels rise above 5.5 mEq/L, with dose adjustments made according to potassium levels and eGFR 1. Key benefits of finerenone include:
- Reduction in the composite risk of kidney failure, sustained decrease in eGFR, and renal death
- Decrease in the risk of cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure
- Complementary benefits when added to standard therapies like SGLT2 inhibitors and ACE inhibitors/ARBs
- Improvement in heart failure outcomes in patients with type 2 diabetes and CKD 1.
From the Research
Clinical Rationale for Adding Finerenone to DKD Treatment
The clinical rationale for adding finerenone to the treatment regimen of patients with Diabetic Kidney Disease (DKD) is based on its efficacy in improving albuminuria, estimated glomerular filtration rate, and reducing the risk of cardiovascular events 2. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has been shown to delay the progression of DKD and reduce cardiovascular mortality in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) 3, 4.
Key Benefits of Finerenone in DKD Treatment
- Reduces the risk of CKD progression and cardiovascular events in patients with DKD 3, 4
- Improves albuminuria and estimated glomerular filtration rate in patients with DKD 2
- Lowers the risk of hospitalization for heart failure (HF) in patients with DKD 3
- Has a lower risk of hyperkalemia compared to steroidal mineralocorticoid receptor antagonists 4
Patient Subgroups and Finerenone Efficacy
Finerenone's efficacy has been evaluated in various patient subgroups, including:
- Patients with baseline HbA1c level <7.5% or ≥7.5% 5
- Patients with or without insulin use at baseline 5
- Results show that finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2DM, regardless of HbA1c levels or insulin use 5
Overall Clinical Rationale
The addition of finerenone to the treatment regimen of patients with DKD is supported by its clinical efficacy in reducing CKD progression and cardiovascular events, as well as its safety profile 2, 3, 4, 5, 6. Finerenone presents a valuable therapeutic option for patients with DKD, particularly those with optimized renin-angiotensin system blockade.