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What you need to know
The renin–angiotensin–aldosterone system (RAAS) and overactivity of the mineralocorticoid receptor are thought to contribute to the pathogenesis and progression of diabetic nephropathy.
Medicines that inhibit RAAS, including ACE inhibitors and angiotensin-II receptor antagonists, have been shown to improve outcomes in people with diabetes and chronic kidney disease and are standard of care.
Finerenone is a non-steroidal mineralocorticoid receptor antagonist and RAAS inhibitor that is licensed for the treatment of chronic kidney disease (stages 3 and 4 with albuminuria) associated with type 2 diabetes in adults.
Data from two large placebo-controlled trials showed that finerenone reduced a composite renal outcome (HR 0.77; 95% CI 0.67 to 0.88; p=0.0002) with a number-needed-to-treat (NNT) of 29; and a composite cardiovascular outcome (HR 0.86; 95% CI 0.78 to 0.95; p=0.002) with an NNT of 42.
Hyperkalaemia is the most common adverse effect with finerenone with an increased risk in people with low estimated glomerular filtration rate, higher serum potassium levels or previous episodes of hyperkalaemia.
Type 2 diabetes and chronic kidney disease (CKD) are both major global health issues. It is estimated that 451 million individuals have diabetes worldwide and that this is anticipated to rise to 693 million by 2045.1 Importantly, diabetes is a leading cause of CKD and renal failure; approximately 20–40% of individuals with diabetes develop CKD and the incidence of end-stage renal failure is expected to rise in line with diabetes.2–4 In the UK, it is estimated that nearly 4 million people have type 2 diabetes, which is the most common cause of CKD and end-stage renal disease.5 In addition to progression to renal failure, diabetes and CKD are both associated with impairment in quality of life and significantly increased risk of cardiovascular (CV) morbidity and mortality.
Current guidance for management of people with type 2 diabetes and CKD includes …
Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).
Provenance and peer review Commissioned; externally peer reviewed.