Is Kerendia (finerenone) effective in treating non-diabetic kidney disease?

Kerendia (Finerenone) in Non-Diabetic Kidney Disease

Currently, Kerendia (finerenone) is not approved or recommended for non-diabetic kidney disease as its proven benefits are limited to patients with type 2 diabetes and chronic kidney disease with albuminuria. 1

Current Evidence and Approval Status

Finerenone is a non-steroidal mineralocorticoid receptor antagonist that has demonstrated significant cardiorenal protective effects, but specifically in the context of diabetic kidney disease:

• Finerenone has been studied extensively in patients with type 2 diabetes and CKD in the FIDELIO-DKD and FIGARO-DKD trials, showing:

  • 23% reduction in kidney disease progression (HR 0.77,95% CI: 0.67-0.88)
  • 14% reduction in composite cardiovascular events (HR 0.86,95% CI: 0.78-0.95)
  • 29% reduction in hospitalization for heart failure 1, 2

• Current guidelines from the American Diabetes Association and KDIGO specifically recommend finerenone for patients with type 2 diabetes and CKD with albuminuria (ACR ≥30 mg/g) who are already on maximum tolerated doses of ACE inhibitors or ARBs 1

Emerging Research in Non-Diabetic CKD

While not yet approved for non-diabetic CKD, there is emerging research suggesting potential benefits:

1. Preclinical Evidence: Recent animal studies have shown that finerenone improves diastolic dysfunction, reduces cardiac fibrosis, and improves cardiac perfusion in a non-diabetic CKD model 3

2. Ongoing Clinical Trials: The FIND-CKD trial (NCT05047263) is currently investigating finerenone in adults with non-diabetic CKD. This phase 3 trial includes 1,584 patients with:

   • UACR ≥200-≤3500 mg/g
   • eGFR ≥25-<90 ml/min/1.73 m²
   • Most common causes: chronic glomerulonephritis (57.0%) and hypertensive/ischemic nephropathy (29.0%)
   • IgA nephropathy representing 26.3% of the total population 4

3. Theoretical Mechanism: Activation of the mineralocorticoid receptor, with consequent inflammation and fibrosis, is likely operative as a pathogenetic mediator in both diabetic and non-diabetic kidney disease 5

Clinical Implications and Monitoring

If considering off-label use (which cannot be recommended until trial results are available):

• Patient Selection: Similar to diabetic CKD criteria, patients would need:

  • eGFR ≥25 ml/min/1.73 m²
  • Serum potassium <4.8 mmol/L
  • No adrenal insufficiency 1

• Hyperkalemia Risk: This is the primary adverse effect of finerenone:

  • In diabetic CKD trials, hyperkalemia occurred in 10.8% of finerenone patients vs. 5.3% with placebo
  • Monitoring of serum potassium at baseline, 1 month after initiation, and every 4 months thereafter would be essential 1

Future Directions

The FIND-CKD trial will provide crucial data on the efficacy and safety of finerenone in non-diabetic CKD. Additionally, the FIONA program is investigating finerenone in children with glomerular and non-glomerular CKD 5.

Until these trials are completed and regulatory approval is obtained, finerenone should only be used for its approved indication in type 2 diabetes with CKD, as recommended by current guidelines 6, 1.