A fine time for finerenone: another kidney drug that works

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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

Many people still see finerenone as 'just another spironolactone ', but is that really the case? In this episode of For Kidney's Sake, Prof Jeremy Levy and Dr Andrew Frankel explore why finerenone is changing the management of diabetic kidney disease and where it fits alongside ACE inhibitors, ARBs and SGLT2 inhibitors.

The discussion covers the evidence behind finerenone, why patients remain at 'residual risk' despite current therapies, and how adding another treatment can further slow the progression of chronic kidney disease while reducing cardiovascular events. Jeremy and Andrew also share practical guidance on prescribing, monitoring potassium safely and overcoming the therapeutic inertia that can prevent patients from receiving effective treatments.

5 Key Takeaways

• Finerenone is not simply another spironolactone. Its selective mechanism and clinical trial evidence make it a distinct treatment for people with diabetic kidney disease.
• Many patients still have 'residual risk'. Even with ACE inhibitors, ARBs and SGLT2 inhibitors, ongoing albuminuria can signal continued kidney disease progression.
• Combination therapy matters. Adding finerenone to existing evidence-based treatments can further reduce the risk of kidney failure and cardiovascular events.
• Hyperkalaemia shouldn't be a barrier. With appropriate patient selection and routine monitoring, finerenone is straightforward to prescribe and generally well tolerated.
• Early optimisation is key. Identifying eligible patients during annual diabetes and CKD reviews gives clinicians the opportunity to protect kidney function before irreversible decline occurs.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

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