Exploring the Benefits of Kerendia (Finerenone) in Treating Chronic Kidney Disease
- Andrew Kowalski
- Nov 11, 2024
- 4 min read
Andrew Kowalski, MD, FASN
Chronic Kidney Disease (CKD) is a serious health condition affecting millions of people worldwide, characterized by a gradual loss of kidney function over time. Left unmanaged, CKD can lead to serious complications, including cardiovascular disease, anemia, and kidney failure. One of the critical developments in the treatment of CKD, particularly in those with type 2 diabetes, is Kerendia (finerenone). In this post, we’ll explore what Kerendia is, how it works, and its significance in the management of CKD.
Image from https://www.kerendia-us.com
What is Chronic Kidney Disease (CKD)?
CKD occurs when the kidneys become damaged and lose their ability to filter blood effectively. This can result in the build-up of waste products and excess fluid in the body. High blood pressure and type 2 diabetes are leading causes of CKD, and over time, these conditions can damage the blood vessels in the kidneys.
Managing CKD often involves lifestyle changes, such as dietary adjustments and controlling blood pressure and blood sugar. However, as CKD progresses, many patients require medication to slow the decline in kidney function and reduce the risk of cardiovascular complications.
What is Kerendia?
Kerendia is a medication approved by the FDA in July 2021 for use in adults with CKD associated with type 2 diabetes. It belongs to a class of drugs known as nonsteroidal mineralocorticoid receptor antagonists (MRAs). MRAs block the effects of the hormone aldosterone, which plays a role in the body’s salt and water balance.
Excessive aldosterone activity can lead to kidney and heart damage by promoting inflammation and fibrosis (scarring) in the kidneys and cardiovascular system. Kerendia works by reducing this harmful process, protecting both kidney function and heart health in patients with CKD.
How Does Kerendia Work?
Kerendia specifically targets mineralocorticoid receptors in the kidneys and heart. By blocking aldosterone, Kerendia helps reduce inflammation and fibrosis in these organs, slowing the progression of kidney disease and reducing the risk of cardiovascular events, such as heart attacks and strokes.
In clinical trials, Kerendia demonstrated significant benefits for patients with CKD and type 2 diabetes. The FIDELIO-DKD trial, one of the key studies, showed that patients treated with Kerendia experienced a slower decline in kidney function and a reduced risk of kidney failure. Additionally, Kerendia helped lower the risk of cardiovascular complications, such as heart attacks and hospitalization for heart failure.
The Importance of Kerendia in CKD Management
CKD, especially in patients with type 2 diabetes, is notoriously difficult to manage, as it involves both kidney and cardiovascular health. Traditional treatments focus on controlling blood pressure and blood sugar levels, but these often fall short in preventing further kidney damage. Kerendia offers a new avenue by addressing one of the underlying mechanisms—aldosterone’s role in inflammation and scarring.
Here are some of the key benefits of Kerendia:
1. Kidney Protection: Kerendia slows the progression of kidney disease by reducing inflammation and fibrosis in the kidneys. FIDELIO-DKA showed a 18% relative risk reduction in progressive renal decline at 36 months
2. Cardiovascular Benefits: By protecting the heart and reducing the risk of cardiovascular events, Kerendia offers dual protection for those with CKD and type 2 diabetes.
3. Reduced Need for Dialysis: Slowing the progression of CKD may delay the need for dialysis or kidney transplant, which are common outcomes of advanced CKD.
4. Improved Outcomes for Diabetic Patients: As CKD and diabetes often coexist, the ability to manage both kidney health and heart health makes Kerendia a valuable addition to the treatment arsenal.
Who Can Benefit from Kerendia?
Kerendia is approved for use in adults with CKD and type 2 diabetes who are at risk of further kidney decline or cardiovascular complications. It is typically prescribed alongside other treatments, such as blood pressure medications (like ACE inhibitors or ARBs), and blood sugar-lowering drugs.
It’s important to note that Kerendia is not a cure for CKD but a treatment designed to slow the disease’s progression. Patients taking Kerendia should continue to follow their healthcare provider’s advice regarding lifestyle changes, including maintaining a kidney-friendly diet, exercising, and keeping blood pressure and blood sugar under control.
Potential Side Effects of Kerendia
Like any medication, Kerendia may have side effects. The most common side effect is hyperkalemia—an elevated level of potassium in the blood—which can be dangerous if left unchecked. Adverse reactions reported in at least 1% of patients taking KERENDIA and occurring more often than in those taking a placebo included hyperkalemia (14% vs 6.9%)( high blood potasium ,levels) hypotension (4.6% vs 3.9%) (low blood pressure), and hyponatremia (1.3% vs 0.7%) (low blood sodium levels).
Because of this risk, patients on Kerendia need regular monitoring of their potassium levels. Other potential side effects may include low blood pressure and dizziness, but these are typically manageable with the guidance of a healthcare provider.
Final Thoughts
Kerendia represents a significant advancement in the treatment of CKD, particularly for patients with type 2 diabetes who are at high risk of kidney and heart complications. By targeting the harmful effects of aldosterone, Kerendia offers dual protection for both the kidneys and the heart, potentially improving long-term outcomes for millions of people living with CKD.
If you or a loved one has CKD and type 2 diabetes, it’s worth discussing with your healthcare provider whether Kerendia might be a suitable option for your treatment plan. While it’s not a cure, it provides a promising step forward in the fight against the progression of kidney disease and its related complications.
New England Journal of Medicine
Pages: 2219-2229
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