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Finerenone (Kerendia): A New Approach to Managing CKD in Type 2 Diabetes

Learn about finerenone (Kerendia) for managing CKD in type 2 diabetes patients. Understand its benefits, risks, and clinical applications.

Finerenone (Kerendia)

Finerenone, marketed as Kerendia💊 is the first nonsteroidal mineralocorticoid receptor antagonist. Approved to slow CKD progression and improve cardiovascular outcomes, finerenone limits fibrosis and inflammation in kidneys and heart by blocking aldosterone effects.

RxPharm-adv

Comparison with Steroidal MRAs

Think of spironolactone (Aldactone) and eplerenone as similar but steroidal options without evidence of improved CKD outcomes.

Key Benefits of Finerenone

  • Adding once-daily finerenone to max ACEI or ARB doses slows CKD progression in about 1 in 30 patients over 2.5 years, mainly by reducing significant eGFR decline.
  • Finerenone also lowers cardiovascular event risk in about 1 in 56 patients by reducing heart failure hospitalizations.

Be aware of finerenone's downsides, including hyperkalemia in up to 1 in 11 patients. Avoid starting finerenone if eGFR is below 25 mL/min/1.73m² and consider its monthly cost.

Place in Therapy for CKD and Type 2 Diabetes

Expect finerenone as a last resort for CKD patients due to type 2 diabetes. Optimize blood pressure and glucose first, along with maximizing ACEI or ARB doses. If a metformin add-on is needed, prefer an SGLT2 inhibitor (empagliflozin, etc) or possibly a GLP-1 agonist (liraglutide, etc) for kidney protection, improved cardiovascular outcomes, and glucose lowering. Note that finerenone doesn't lower glucose.

Don't anticipate finerenone on your formulary. It's okay to hold during admission, missing doses won't likely affect outcomes. At discharge, restart finerenone at the patient's home dose.

RxPharm-adv

Take-home points

Discover finerenone (Kerendia) for CKD in type 2 diabetes...

  1. Recognize finerenone (Kerendia) as a nonsteroidal mineralocorticoid receptor antagonist.
  2. Understand that finerenone slows CKD progression and improves cardiovascular outcomes.
  3. Note that finerenone limits fibrosis and inflammation in kidneys and heart.
  4. Avoid finerenone if eGFR is below 25 mL/min/1.73m² due to hyperkalemia risk.
  5. Use finerenone as a last resort, optimizing BP and glucose first.

References

  1. Bakris GL, Agarwal R, Anker SD, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020;383(23):2219-2229. doi:10.1056/NEJMoa2025845
    2. Show more references

Keywords: Finerenone, Kerendia, Chronic Kidney Disease, CKD, Type 2 Diabetes, Cardiovascular Outcomes, Nonsteroidal Mineralocorticoid Receptor Antagonist, Hyperkalemia, eGFR, Blood Pressure Management

Senior clinical pharmacist, "Pharmacy Practice Department, Tanta University Hospital, Egypt". Medical content writer.