Slowing down CKD in patients with type 2 diabetes

3 minute read

Finerenone is now available on the PBS, adding to GPs’ ability to improve outcomes for patients with type 2 diabetes.

A drug that slows progression of chronic kidney disease in adult patients with type 2 diabetes has been listed on the PBS.

An Australian expert says the medication offers a new way for GPs to prevent serious complications, and its listing is a reminder to be alert to and test for asymptomatic disease. 

“These drugs can really fundamentally change the course of chronic kidney disease in our type 2 patients,” Dr Gary Deed, chair of the RACGP’s diabetes specific interest group, told TMR.

Finerenone (Kerendia, Bayer) is the first non-steroidal selective mineralocorticoid receptor antagonist in its class for diabetic kidney disease. It targets the overactivation of the mineralocorticoid receptor which produces the inflammation and fibrosis that advance kidney disease progression.

The combination drug is for use together with an SGLT2 inhibitor, in addition to standard treatment.

“This complements what SGLT inhibitors have been shown to do. It’s a wonderful time where the new therapies are emerging that can finally make a difference to people with diabetes and chronic kidney disease,” Dr Deed said.

The new drug is indicated for patients with type 2 diabetes and chronic kidney disease, with an estimated glomerular filtration rate (eGFR) of 25mL/min/1.73m2 or greater and a urinary albumin-to-creatinine ratio of 200mg/g (22.6mg/mmol).

The patient must have been stabilised for at least four weeks on an ACE inhibitor or an angiotensin II receptor antagonist and not have established heart failure with reduced ejection fraction.

“Chronic kidney disease is a silent illness,” Dr Deed said. “This new class of drugs is a reminder to be more vigilant about what can be an asymptomatic disease and also more vigilant about assessing patients for the risk of development so we can intervene.”

Type 2 diabetes is the leading cause of CKD, which contributes to 12% of all deaths in Australia according to the Australian Institute of Health and Welfare. Guidelines recommend yearly albuminuria screening for these patients, along with control of blood pressure through RAS inhibitors, glucose control, weight management, exercise and not smoking. Newer additions to the pharmaceutical arsenal are SGLT2 inhibitors and now finerenone.

Trials have shown the risk of primary outcome events (kidney failure, a sustained decrease of at least 40% in the eGFR from baseline over a period of four weeks or more, or death from renal causes) and secondary outcomes (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalisation for heart failure) was 22% lower in people being treated with finerenone compared with a placebo.

The most common side effect in trial participants was hyperkalaemia, which occurred in 18.3% of the treatment group and 9% of the placebo group.

The product information warns that some patients, including those who have had prior episodes, have low eGFR or higher serum potassium, are at higher risk of hyperkalaemia and need to be monitored more frequently.

Finerenone cannot be used in conjunction with strong CYP3A4 inducers, potassium-sparing diuretics, other mineralocorticoid receptor antagonists and grapefruit, and is not recommended for use during pregnancy or breast feeding (category D).

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