Finerenone: a game changer for chronic kidney disease patients with type 2 diabetes

Abstract

Dear Editor,

Type 2 diabetes or (T2D) is characterized by the elevated blood glucose levels resulting from impaired beta-cell function and insulin resistance. According to the International Diabetes Federation (IDF), 1 in 10 people globally suffer from diabetes mellitus. The comparative adult prevalence rate of diabetes mellitus in Pakistan is estimated to be 30.8 % (1).

One of the most prevalent complications of Type 2 Diabetes is chronic kidney disease (CKD). CKD is estimated to affect 50% of the population suffering from T2D (2). Traditionally, RAAS and SGLT-2 inhibitors are used as interventions to decline the progression of CKD. While effective, a novel therapeutic option, finerenone, has recently emerged as a breakthrough in improving both renal and cardiovascular outcomes in patients with CKD and T2D (3).

Finerenone is a non-steroidal mineralocorticoid receptor antagonist that selectively inhibits aldosterone’s effects at its receptor. Unlike steroidal mineralocorticoid receptor antagonists (MRAs) such as spironolactone and eplerenone, finerenone offers significant renal protection without causing substantial elevations in serum potassium levels (4). Clinical trials have demonstrated that finerenone significantly reduces the urine albumin-to-creatinine ratio, slows estimated glomerular filtration rate (eGFR) decline, and mitigates progression to end-stage renal disease (5). Furthermore, finerenone does not cause significant rise in serum potassium levels which is a major side effect of steroidal mineralocorticoid receptor antagonists i.e. spironolactone and eplerenone. Thus, finerenone has almost the same effect along with a lower risk of hyperkalaemia as compared to that of steroidal mineralocorticoid receptor antagonists (4).

Moreover, the lower risk of hyperkalaemia associated with finerenone makes it a safer alternative for long-term use. The drug’s beneficial effects in combination with RAAS and SGLT-2 inhibitors are now reflected in international treatment guidelines for CKD management in patients with T2D (3).

With the recent availability of finerenone in Pakistan, it is the need of the hour to spread the word about this ground breaking drug and revise guidelines across urban and rural health care settings of Pakistan so that mortality and morbidity can be reduced amongst patients with CKD in T2D. Through these steps, the disease burden of end stage kidney failure amongst T2D patients in Pakistan can be reduced eventually.