Optimization of potassium management in patients with chronic kidney disease and type 2 diabetes on finerenone
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Published on: April 4, 2025
Alberto Ortiz1, Roberto Alcázar Arroyo2, Pedro Pablo Casado Escribano3
1Nephrology and Hypertension Department, IIS-FJD and Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Introduction:
Patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD) are at high risk of CKD progression and cardiovascular events. Despite treatment with renin-angiotensin system inhibitors and SGLT-2 inhibitors, the residual risk is substantial. There is preclinical and clinical evidence supporting a key role of mineralocorticoid receptor in cardiorenal injury in T2DM.
Areas Covered:
Finerenone is a selective and nonsteroidal mineralocorticoid receptor antagonist that reduces -on preclinical studies- heart and kidney inflammation and fibrosis. Clinical trials have demonstrated that among patients with T2DM and CKD, finerenone reduces CKD progression and the risk of cardiovascular events. The incidence of adverse events is similar than for placebo. Permanent discontinuation of study drug due to hyperkalemia was low (1.7% of finerenone and 0.6% of placebo participants) as was the risk of hyperkalemia-related severe-adverse events (1.1%). We provide an overview of risk factors for hyperkalemia and management of serum potassium in people with CKD and T2DM on finerenone.
Expert Opinion:
As finerenone increases potassium levels in a predictable way, patients at risk of hyperkalemia can be identified early in clinical practice and monitored for an easy management. This will allow people with T2DM and CKD to safely benefit from improved cardiorenal outcomes.
Insights
Finerenone effectively reduces cardiorenal risk in type 2 diabetes and chronic kidney disease patients. Careful monitoring manages predictable potassium increases, ensuring safe cardiorenal outcome benefits.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD) face high risks of disease progression and cardiovascular events.
- Existing treatments like renin-angiotensin system inhibitors and SGLT-2 inhibitors leave a substantial residual risk.
- Mineralocorticoid receptor activation plays a key role in cardiorenal injury in T2DM.
Purpose of the Study:
- To review the role of finerenone, a selective mineralocorticoid receptor antagonist, in managing cardiorenal risk in T2DM and CKD.
- To discuss the efficacy of finerenone in reducing CKD progression and cardiovascular events.
- To outline strategies for managing hyperkalemia risk associated with finerenone therapy.
Main Methods:
- Review of preclinical and clinical trial data on finerenone's effects on cardiorenal outcomes.
- Analysis of adverse event profiles, specifically focusing on hyperkalemia incidence and management.
- Examination of risk factors for hyperkalemia in patients with T2DM and CKD treated with finerenone.
Main Results:
- Finerenone demonstrated reduction in CKD progression and cardiovascular events in clinical trials.
- The incidence of adverse events, including hyperkalemia, was comparable to placebo.
- Permanent discontinuation due to hyperkalemia was low (1.7% for finerenone vs. 0.6% for placebo).
Conclusions:
- Finerenone offers significant cardiorenal benefits for patients with T2DM and CKD.
- Hyperkalemia risk is predictable and manageable through early identification and monitoring.
- This approach allows patients to safely leverage finerenone for improved cardiorenal outcomes.
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