Medication Highlight: Kerendia [Finerenone]
Therapeutics for chronic kidney disease is a rapidly changing field which aims to focus on slowing the progression of worsening renal function. From ACE inhibitors, ARBs, statins and newly SGLT2 inhibitors, we now have another tool to further optimize the care for these patients. ------------ Finerenone, marketed as Kerendia, is a novel mineralocorticoid receptor antagonist and potassium-sparing diuretic. It is approved as add-on therapy in patients with a history of type 2 diabetes-related chronic kidney disease receiving standard care (at least ACE inhibitor/ARB and diabetic medication) to reduce the worsening progression of kidney function towards end-stage renal disease, as well as improve cardiovascular outcomes such as death, non-fatal myocardial infarction and heart failure hospitalization. ------------ Finerenone works by blocking aldosterone from binding to its respective mineralocorticoid receptors. These receptors are present in blood vessels, kidneys and heart, which may explain why finerenone has cardiovascular benefits. Its clinical utility is to help diabetic patients who are experiencing a continued decrease in renal function despite being on an ACE inhibitor or ARB.
This specificity to mineralocorticoid receptors, as well as lack of affinity to glucocorticoid and androgen receptors, means that it has an advantage over spironolactone and eplerenone to reduce adverse effects such as low libido, sexual dysfunction and gynecomastia. ------------ Finenerone’s starting dose is dependent on the renal function: either 10 mg daily (for eGFR between 25 to 60 mL/min) or 20 mg daily (for eGFR greater than 60 mL/min). The maximum dose and target dose is 20 mg once daily. It can be taken with or without food. ------------ The most common adverse effects of finerenone are electrolyte-based - mainly hyperkalemia and hyponatremia. Patients will also need to be monitored for hypotension as well. It should not be used in pregnant women due to risk of fetal harm. ------------ It is important to pay attention to drug interactions because finerenone is metabolized by CYP3A4. Strong CYP3A4 inhibitors are contraindicated such as clarithromycin and ritonavir. Strong or moderate CYP3A4 inducers are not recommended either. As well, concomitant use with potassium supplements and trimethoprim may increase the risk of hyperkalemia.