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.

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.

Further information: 

• Finerenone in the management of Diabetic Kidney Disease: A consensus statement by the Association of British Clinical Diabetologists and UK Kidney Association (abcd.care)