Finerenone in diabetic kidney disease (Guideline)
TAM (Treatments and Medicines) NHS Highland
Warning
Audience
- All NHSH
- Primary and Secondary care
- Adults only
Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA) approved for the treatment of chronic kidney disease (stage 3 and 4 with proteinuria) associated with type 2 diabetes in adults.
In addition to RAS blockade, finerenone has been shown to reduce the risk of a primary composite renal outcome (kidney failure, sustained decrease in eGFR or death from renal cause) compared with placebo.
Finerenone can be used as a second line drug in addition to ACE inhibitor or angiotension receptor blocker (if SGLT2i not tolerated or contraindicated) or as part of third line therapy in addition to ACEI/ARB + SLGT2i.
- Finerenone will mostly be initiated and monitored by secondary care until the patient is on a stable dose, usually by 4 weeks.
- Ongoing supply will be with the patient’s GP.
- Alternatively, where a GP may seek advice, then the medication could be commenced in primary care on the advice of secondary care, with appropriate monitoring as per the protocol.
There is a risk of hyperkalaemia. This needs to be closely monitored on initiation.
Secondary Care monitoring:
- Monitoring at initiation and until patient is on a stable dose, usually up to four weeks, will be carried out by secondary care (unless initiated by primary care on advice of secondary care).
Primary care monitoring:
- Potassium requires to be carefully monitored. Once patient is on a stable dose, potassium should be checked approximately every 4 months.
Consultant advice should be sought in the following situations:
- Persistent hyperkalaemia despite dose adjustment as per guideline
- Deterioration in renal function
- Any adverse effects to treatment
- Failure of patient to attend for necessary monitoring