Finerenone (Kerendia), a nonsteroidal mineralocorticoid receptor antagonist, was recently approved to reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with chronic kidney disease associated with type 2 diabetes. Finerenone is taken orally once a day.

The clinical trial for finerenone was a randomized, double-blind, placebo-controlled, multicenter study in 5,674 adult patients with chronic kidney disease associated with type 2 diabetes. Patients receiving finerenone had a significant reduction in the composite end point of sustained eGFR decline, kidney failure, or renal death compared with placebo. The incidence of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure was also lower with finerenone use compared with placebo.

Finerenone carries a warning that it may produce hyperkalemia and that serum potassium levels should be monitored during therapy. Patients with adrenal insufficiency who are likely to already have hyperkalemia should not receive finerenone. Adverse reactions also include hypotension and hyponatremia.

Because finerenone is a cytochrome P-450 (CYP) 3A4 substrate, the concurrent use of strong CYP3A4 inhibitors will decrease finerenone metabolism and increase circulating levels of the drugs, increasing the risk of adverse effects. Even moderate to weak CYP3A4 inhibitors may increase the amount of circulating finerenone, requiring more frequent testing of potassium levels. Drugs that are strong or moderate CYP3A4 inducers can decrease the availability of finerenone and its effectiveness. These drugs should also be avoided.

Patients receiving finerenone should avoid potassium supplements or salt substitutes with potassium. Patients should be told that breastfeeding is not recommended.

For complete prescribing information for finerenone, go to http://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215341s000lbl.pdf.