From the Guidelines
Kerendia (finerenone) is recommended for adults with chronic kidney disease (CKD) associated with 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), as it has been shown to reduce the risk of progression from stage A heart failure to symptomatic incident heart failure, as well as reduce the risk of cardiovascular events, including cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure, as demonstrated in the FIDELIO-DKD and FIGARO-DKD studies 1.
Key Considerations for Kerendia Use
- 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.
- Before starting Kerendia, serum potassium should be ≤4.8 mEq/L, and potassium levels should be monitored regularly during treatment, especially within the first 4 weeks, due to the increased risk of hyperkalemia, as seen in the FIGARO-DKD trial 1.
- Kerendia should not be used in patients with severe CKD (eGFR <25 mL/min/1.73m²) or those on dialysis.
- Patients should avoid potassium supplements and high-potassium foods while taking this medication.
- Kerendia works by blocking mineralocorticoid receptors, reducing inflammation and fibrosis in the kidneys and heart, which helps slow CKD progression and reduces cardiovascular risks in diabetic patients, as supported by the consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1.
Integration with Standard Treatments
- Kerendia should be used alongside standard treatments including ACE inhibitors or ARBs, glucose-lowering medications, such as SGLT2 inhibitors, and lifestyle modifications, such as a healthy diet, physical activity, smoking cessation, and weight management, as recommended by the ADA and KDIGO guidelines 1.
- A team-based integrated approach, engaging diabetes care and education specialists, physicians, nurse practitioners, physician assistants, nurses, dietitians, exercise specialists, pharmacists, dentists, podiatrists, and/or mental health professionals, is essential for the care of patients with diabetes and CKD, as emphasized by the ADA and KDIGO guidelines 1.
From the Research
Guidelines for CKD and Type 2 Diabetics Regarding Kerendia
- Kerendia (finerenone) is a nonsteroidal mineralocorticoid receptor antagonist that has been shown to reduce kidney and cardiovascular risks in patients with CKD and type 2 diabetes 2, 3, 4, 5.
- The recommended use of Kerendia is for the treatment of CKD with albuminuria in adult patients with type 2 diabetes 3.
- Kerendia has been associated with significant reductions in kidney- and CV-related endpoints compared with placebo, with minimal effects on serum potassium and kidney function in phase III trials 2, 5.
- The safety profile of Kerendia is excellent, but a significant increase in serum potassium level was observed, requiring caution regarding patient selection and monitoring 3, 4, 5.
Key Considerations
- Kerendia should be used in combination with a renin-angiotensin blocker, with the dose adjusted to the maximum tolerated dose before initiating Kerendia therapy 4, 5.
- Patients with CKD and type 2 diabetes should be monitored for hyperkalemia, with regular measurements of serum potassium levels 3, 4, 5.
- The use of Kerendia in patients with CKD and type 2 diabetes has been shown to improve cardiovascular outcomes, including a lower incidence of hospitalization for heart failure 4.
Ongoing Research
- The CONFIDENCE study is currently investigating the safety, tolerability, and efficacy of dual therapy with Kerendia and an SGLT2 inhibitor in adults with CKD and type 2 diabetes 6.
- The study aims to demonstrate whether dual therapy with Kerendia and an SGLT2 inhibitor is superior to either agent alone in reducing albuminuria and improving kidney and cardiovascular outcomes 6.