Revisions of standard treatment guidelines for patients with type 2 diabetes and chronic kidney disease were made in 2022 by the American Diabetes Association and the Kidney Disease: Improving Global Outcomes Diabetes Work Group. These revisions included the new treatment option of finerenone (Kerendia), a nonsteroidal mineralocorticoid receptor antagonist. Finerenone selectively blocks the mineralocorticoid receptor activated by aldosterone and cortisol and blocks sodium reabsorption and receptor overactivation in epithelial (such as kidney) and nonepithelial (such as heart and blood vessels) tissues. The overactivation of the mineralocorticoid receptor is believed to contribute to fibrosis and inflammation.

Finerenone was originally approved in 2021 to reduce the risk of sustained estimated glomerular filtration rate decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease associated with type 2 diabetes. The drug is given orally each day.

The addition of finerenone to the guidelines was based on the results of two double-blind trials in patients with chronic kidney disease and type 2 diabetes with and without cardiovascular disease. The data showed that finerenone was better than placebo in reducing renal and cardiovascular deaths.

Finerenone is expensive, with a 30-day supply costing about $600. The cost varies depending on whether the patient has insurance, the type of insurance, and the pharmacy that fills the prescription. NPs who prescribe finerenone may need to have the patient obtain preauthorization from their insurer. For the Medical Letter news brief on the addition of finerenone to guidelines for type 2 diabetes and chronic kidney disease, see https://secure.medicalletter.org/TML-article-1668e.