Extra Protection? Finerenone Use in Patients with Type 2 DM and CKD

Authors:
Katherine Montag Schafer, PharmD, BCACP, CDCES
Kyle Hunt, MD

Reviewers:
Stefanie Nigro, PharmD, BCACP
Kimberly Zitko, PharmD, BCACP, BCGP

Bakris GL, Agarwal R, Anker SD, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes.N Engl J Med. 2020;383(23):2219-29.

The Problem

Meet Frank, a 54-year-old-male who recently started hemodialysis due to chronic kidney disease (CKD) from long-standing uncontrolled hyperglycemia from type 2 diabetes. At his last appointment, he shares his dialysis experiences, new challenges, and the decline in his quality of life. Despite all the visits and wins over the past few years to control his diabetes and mitigate other risk factors, we weren’t successful at preventing this outcome. It’s hard not to feel like we have failed Frank. What else could we have done?

Prevention of macrovascular and microvascular complications, like CKD, is the driving force for controlling diabetes and other risk factors. The CDC estimates that nearly 1 in 10 Americans have diabetes, disproportionately affecting individuals of color.¹ In addition to hyperglycemia, risk factors for the development of CKD include obesity, smoking, and elevated blood pressure — all of which are common among patients with diabetes.^{2, 3}

Despite prevention efforts, about 1 in 3 patients diagnosed with diabetes have comorbid CKD.  Half of these individuals with moderate to severe disease.⁴ Unlike patients with type 1 diabetes where it develops after many years after the diagnosis, CKD is commonly present at diagnosis in patients with type 2 diabetes.⁵ While many interventions are available to prevent the progression of CKD, more are needed.