Finerenone

Finerenone is a nonsteroidal, selective mineralocorticoid receptor antagonist (MRA) approved for the treatment of chronic kidney disease (CKD) in adults with type 2 diabetes mellitus (T2DM). Marketed as Kerendia by Bayer, it received regulatory approval in the United States in 2021 and is used in addition to standard care, including renin–angiotensin system blockade such as ACE inhibitors or ARBs. The goal of therapy is to reduce the risk of a sustained decline in kidney function, progression to end-stage kidney disease, and cardiovascular events in patients with CKD and T2DM.

Mechanism of action: Finerenone binds selectively to the mineralocorticoid receptor, modulating inflammatory and fibrotic pathways in kidneys and heart. Compared with steroidal MRAs, finerenone has a distinct binding profile that is associated with a lower likelihood of certain endocrine side effects, such as those related to androgen or progesterone receptors, contributing to a different safety and tolerability profile.

Clinical evidence and indications: Finerenone was evaluated in two large trials, FIDELIO-DKD and FIGARO-DKD, which demonstrated reductions in composite renal and cardiovascular outcomes when added to standard therapy in adults with CKD and T2DM. It is indicated for CKD in adults with T2DM and is generally used as part of a comprehensive regimen that includes blood pressure control and glycemic management.

Dose, monitoring, and safety: Finerenone is taken orally once daily, with dosing adjusted based on potassium levels and kidney function. Common adverse effects include hyperkalemia, so potassium and renal function should be regularly monitored. It should be used with caution in patients at risk of high potassium and in those taking other medications associated with hyperkalemia. Contraindications and precise dosing guidelines are provided in the official labeling.