Medication For Kidney Disease In Diabetes Is Approved By the FDA

By Jessica Pyhtila, PharmD, BCGP, BCPS

The FDA recently approved finerenone (Kerendia), an oral non-steroidal mineralocorticoid receptor antagonist. The medication is approved to reduce the risk of sustained eGFR decline, end stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease associated with type 2 diabetes.

Finerenone works by blocking sodium reabsorption and mineralocorticoid receptor overactivation in both kidney and other vascular tissues. This overactivation is believed to contribute to both fibrosis and inflammation, which lead to permanent kidney damage.

The drug is available as an oral tablet in strengths of 10mg and 20mg. Patients must have their potassium levels checked before starting the medication. The drug should not be initiated if the serum potassium exceeds 5.0 mEq/L. For patients with an acceptable potassium level, the starting dose of finerenone is based on the patient’s renal function:

— eGFR greater than or equal to 60 mL/min/1.73m2: starting dose of 20mg daily

— eGFR greater than or equal to 25, but less than 60 mL/min/1.73m2: starting dose of 10mg daily

— eGFR less than 25 mL/min/1.73m2: use is not recommended

Following initiation or dose adjustment, serum potassium levels should be rechecked after 4 weeks. The dose may then need to be adjusted depending on both the serum potassium concentration as well as the patient’s current dose of the medication. The most notable side effect of finerenone is hyperkalemia.

Finerenone is a CYP3A4 substrate. As such, it should not be used in patients taking strong CYP3A4 inhibitors, as this increases the patient’s exposure to finerenone. Strong CYP3A4 inhibitors include clarithromycin, erythromycin, diltiazem, verapamil, itraconazole, ketoconazole, ritonavir, and grapefruit. It should also be avoided in those taking CYP3A4 inducers like phenobarbital, phenytoin, and rifampin. The drug is also contraindicated in patients with adrenal insufficiency.

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