Kerendia Safety in Heart Failure with Frequent Volume Overload

Evidence Supporting Safety and Efficacy

The American College of Cardiology recommends continuing loop diuretics as needed for volume management, as finerenone does not replace diuretic therapy, and cautious diuresis should proceed even in presence of mild hypotension 1, 2
The European Heart Journal suggests considering combination diuretic therapy (loop diuretic plus thiazide-type) if volume overload persists, but monitoring potassium more frequently when adding finerenone 2

The European Heart Journal recommends checking potassium and renal function within 4 weeks of initiation, then regularly thereafter based on clinical stability, and if potassium rises to 5.5-6.0 mmol/L, reducing finerenone dose or temporarily discontinuing, and adjusting other potassium-affecting medications 3
The European Society of Cardiology suggests that elderly patients are at higher risk for hyperkalemia when combining aldosterone antagonists with ACE inhibitors/ARBs, but this combination is often necessary and can be managed with monitoring 3, 4

The American Heart Association recommends verifying eGFR ≥25 mL/min/1.73 m² as minimum threshold, and not withholding finerenone solely because of frequent volume overload, as this was the studied population 1, 2
The European Heart Journal suggests that if symptomatic hypotension develops, assessing volume status first, and if truly volume overloaded, continuing finerenone and optimizing diuretic regimen rather than discontinuing the MRA 1