Finerenone is a Key Medication for Diabetic Kidney Disease

Diabetes and Kidney Health

People with diabetes are at a high risk of developing kidney disease in the future. Therefore, it is crucial to monitor kidney function regularly. One effective way to do this is by checking urinary protein levels. Among these, urinary albumin (also called albuminuria) is particularly important. Individuals with diabetes should undergo a urine test annually to check for urinary albumin.

Reducing urinary protein (proteinuria) can help slow the progression of kidney damage. One of the medications proven to achieve this is finerenone, which I will introduce in detail.

What Is Finerenone?

Finerenone is a non-steroidal selective mineralocorticoid receptor antagonist (MRA). It works by preventing the overactivation of mineralocorticoid receptors in the heart and kidneys, which directly reduces inflammation and fibrosis in the kidneys.

How Does Finerenone Work?

In the diagram below, the left section shows how aldosterone binds to mineralocorticoid receptors (MR), causing inflammation and fibrosis in the kidney. Finerenone instead binds to these receptors, effectively blocking the harmful pathway.

Results from Phase III Clinical Studies

Recent Phase III studies focused on the effects of finerenone in patients with type 2 diabetic kidney disease. A retrospective analysis of a double-blind study confirmed:

• Health benefits associated with reduced urinary albumin within 4 months of starting finerenone.
• Effects on kidney function and cardiovascular health over a maximum of 4 years.

Key Findings:

• A 30% or greater reduction in urinary albumin led to:
  • 64% lower risk of kidney disease progression.
  • 26% lower risk of cardiovascular events and mortality.

Comparative Results: Finerenone vs Placebo

The graph below demonstrates the superior efficacy of finerenone in reducing proteinuria compared to a placebo:

• Figure B: The line at log 0.7 = -0.36 represents a 30% or greater reduction in urinary albumin. Finerenone clearly showed a more significant effect.
• Figure C: Focuses on kidney disease progression.
• Figure D: Highlights cardiovascular outcomes.

When urinary albumin decreased by more than 30%, there was a clear reduction in kidney function decline and cardiovascular events.

Proportion Mediated Method Results

The table below evaluates finerenone’s effects using the proportion mediated method. This method calculates the proportion of the treatment effect achieved relative to its expected effect.

• Kidney effects: 84% efficacy.
• Cardiovascular effects: 37% efficacy.

Conclusion

Finerenone is a promising treatment for diabetic kidney disease, showing clear benefits in reducing urinary albumin, slowing kidney disease progression, and lowering cardiovascular risks. Regular urine testing and effective treatments like finerenone can play a crucial role in managing diabetes and protecting kidney health.

Reference: Ann Intern Med. doi:10.7326/M23-1023

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chronic kidney disease (CKD) and atrial fibrillation (AF)