• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

Support us:

1. Support us by purchasing our book - Click here for more details: Volume 1- THE BEST OF NOTES IN ENDOCRINOLOGY BOOK SERIES
2. Support you by Becoming a YouTube member (Click here)

Connected Notes:

• Overview of the management of diabetic kidney disease
• Updates on Management of Diabetic kidney disease

Video Lecture

Q. What is Finerenone ?

• Finerenone, sold under the brand name Kerendia, is a medication used to reduce the risk of kidney function decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure in adults with chronic kidney disease associated with type 2 diabetes. Finerenone is a non-steroidal mineralocorticoid receptor antagonist(MRA)

Q. How does Finerenone compare to other steroidal mineralocorticoid receptor antagonists MRA ?
- It is a non-steroidal MRA
- It has high potency and selective to mineralocorticoid receptor
- It has a short half life of 2-3 hours
- Little effect on BP
- Less hyperkalemia
- No sexual side effects
- No CNS penetration

• Q. What is the dose of Finerenone ?

  • 10 - 20 mg OD

• Q. What is difference between FIDELIO-DKD and FIGARO-DKD ?

  • FIDELIO-DKD looked at renal outcomes as the primary end point
  • FIGARO-DKD looked at CV outcomes as the primary end point

• Q. Which patients were included in these trials?

  • Albuminuria 30-300 with eGFR 25-90 - A2 + G1/G2/G3
  • Albuminuria >300 with eGFR - >60 - A3 + G1/G2
  • 

• Q. What was the duration of the follow-up of these patients?

  • It was 2-3 years

• Q. What was the main driver of the CV benefit in the Finerenone group?

  • Reduction of hospitalization due to heart failure

• Q. What were the renal end points studied?

  • 1. Kidney failure- defined as eGFR <15
  • 2. Sustained >40% reduction in eGFR from baseline
  • 3. Renal death

• Q. How much potassium increase is expected?

  • 0.2 meq/l

• Q. What is FIDELITY study ?

  • This was pooled analysis of the two studies

• Q. What is the indication of Finerenone as per the AACE guideline ?

  • 1. Type 2 diabetes
  • 2. eGFR- >25
  • 3. UACR >30
  • 4. On maximum dose of RAAS blocker

• Q. What should be the baseline potassium level before starting Finerenone ?

  • <4.8 - can start
  • 4.8-5.0- caution
  • More than 5.0- Not recommended

• Q.What should be the starting dose of Finerenone ?

  • It is based on eGFR
    • <25- not recommended
    • 25-60- 10 mg OD
    • More than 60- 20 mg OD

• Q. How should the dose be monitored based on potassium levels?

  • Potassium on follow-up
    • <4.8- Can consider increasing to 20 mg if a patient is on 10 mg
    • 4.8-5.5 - continue the same dose (10 or 20 mg)
    • More than 5.5- stop treatment- restart if potassium <5.0

• Q. What are the 5 , '5s' for Finerenone therapy ?

  • initiate with eGFR >25
  • Initiate when potassium <5.0
  • With-hold when potassium >5.5
  • It reduces ESKD in 1 in 5 patients
  • It reduces heart failure risk in 1 in 5 patients