finérénone

Finerenone (finérénone) is a non-steroidal, selective mineralocorticoid receptor antagonist (MRA) approved for adults with chronic kidney disease caused by type 2 diabetes. It is intended to be used in addition to optimized standard of care, including renin–angiotensin system inhibitors such as ACE inhibitors or ARBs. Finerenone has been studied to slow progression of kidney disease and reduce cardiovascular risk in this population.

Pharmacology: By antagonizing the mineralocorticoid receptor, finerenone dampens inflammatory and fibrotic pathways in kidney and heart tissue. Compared with steroidal MRAs, it is non-steroidal and shows selective tissue effects, which may influence both efficacy and safety, particularly regarding electrolyte balance.

Clinical evidence and approval: Finerenone was evaluated in large trials in adults with DKD, including the FIDELIO-DKD and FIGARO-DKD programs, which showed reduced risk of sustained eGFR decline, progression to end-stage kidney disease, and selected cardiovascular outcomes. Based on these data, regulators approved finerenone for adults with DKD to reduce kidney and cardiovascular risk. It is marketed under the brand Kerendia.

Administration and safety: Finerenone is taken by mouth, with dose adjustments based on potassium levels and kidney function. The most important safety concern is hyperkalemia, which requires regular monitoring of serum potassium and renal function, especially in patients with advanced CKD or those taking other potassium‑raising medications. Adverse effects may include hypotension and dizziness. Potential drug interactions exist with strong inhibitors or inducers of CYP3A4.