Finerenone for Chronic Kidney Disease and Heart Failure

Patient Selection and Dosing

The American Diabetes Association recommends finerenone at 10-20 mg once daily for adults with type 2 diabetes and chronic kidney disease (eGFR ≥25 mL/min/1.73 m²) who have persistent albuminuria (UACR ≥30 mg/g) despite maximum tolerated renin-angiotensin system blockade, to reduce cardiovascular events and CKD progression 1, 2
Patients with type 2 diabetes and CKD should have albuminuria (UACR ≥30 mg/g) to be eligible for finerenone therapy, with an eGFR ≥25 mL/min/1.73 m² 1, 3
The initial dose of finerenone should be determined based on eGFR, with 10 mg once daily for eGFR 25-60 mL/min/1.73 m² and 20 mg once daily for eGFR >60 mL/min/1.73 m² 1, 3, 4

Finerenone reduces the risk of composite cardiovascular death, nonfatal MI, nonfatal stroke, and heart failure hospitalization by 14% (HR 0.86, 95% CI 0.78-0.95) 2
Finerenone also reduces the risk of heart failure hospitalization by 29% (HR 0.71, 95% CI 0.56-0.90) and progression to end-stage kidney disease by 36% (HR 0.64, 95% CI 0.41-0.995) 1, 2
Hyperkalemia is the primary adverse effect of finerenone, occurring in 10.8% of patients compared to 5.3% with placebo, but is manageable with proper monitoring and dose adjustments 1, 5

Finerenone can be used in combination with SGLT2 inhibitors, with potentially additive benefits, and should be considered as second-line therapy for patients with persistent albuminuria already on SGLT2 inhibitors or GLP-1 receptor agonists 2, 4, 5
Regular monitoring of potassium levels is critical to prevent hyperkalemia, with checks at baseline, 4 weeks after initiation, and throughout treatment 3, 5