Finerenone, drug marketed under the trade name “Kerendia,” is recommended for adult patients with chronic kidney disease associated with Type 2 diabetes to reduce cardiovascular mortality, non-fatal myocardial infarction, hospitalisation for heart failure, renal impairment, and renal failure.[1] Functioning as a discerning mineralocorticoid receptor antagonist, it acts by impeding the actions of specific endogenous steroids that have the potential to inflict harm upon the cardiac and renal systems.[2] Adult patients with type 2 diabetes who also have chronic kidney disease, which can get worse over time and lead to the kidneys failing, are treated with finerenone.[2,3] This therapy may lessen the chance of renal disease deteriorating, heart failure requiring hospitalisation, a life-threatening blood vessel illness, or a heart attack.[2]

Finerenone received authorization for medicinal use on July 2021 in the United States (US) and on February 2022 in the European Union (EU). It is approved for treating individuals with type 2 diabetes and chronic renal disease (Stages 3 and 4 with albuminuria).[1] After the approval of finerenone in both the European Union (EU) and the United States (US), there have been safety concerns associated with its use. Patients should let their doctor or chemist know if they are allergic to finerenone or if they have any other allergies before taking it. This item can have inactive components that could lead to allergic reactions or other issues.[3] Additionally, patients must disclose to their physician or chemist any prescription or non-prescription drugs, vitamins, nutritional supplements, and herbal items that they are using. Drugs that may raise the blood potassium level, such as drospirenone-containing birth control pills, ACE inhibitors, potassium-sparing diuretics, and angiotensin receptor blockers, are some items that may interact with finerenone.[3]

In brief studies including individuals with diabetes type 2 and chronic renal disease, finerenone were found to lower albuminuria. It is being researched for its potential to minimize the negative effects of the heart and kidneys in people with diabetes and kidney disease. Recent research indicates that finerenone may be a good treatment option for diabetics and albuminuria with normal blood pressure. In a phase 2 study of finerenone, a dose-dependent decrease in urine albumin to creatinine ratio was seen. In both patients with and without a history of cardiovascular disease, finerenone significantly decreased the risk of cardiovascular and kidney failure outcomes, according to the results of phase 3 randomized, placebo-controlled, double-blind FIDELIO-DKD study.[4–6]

The pivotal ESCAPE trial, which served as the foundation for the FDA approval, showcased the remarkable potential of finerenone. The trial revealed that compared to a placebo, finerenone led to a remarkable 18% reduction in the risk of death and an impressive 23% reduction in the risk of hospitalization for heart failure. These findings underscore the pivotal role of finerenone in improving survival and reducing the burden of hospitalization, thereby offering patients with T2D and CKD who have HFrEF a much-needed treatment option.

When high blood pressure is resistant, it does not respond well to forceful medical intervention. If someone is taking three or more different blood pressure drugs at their highest tolerable doses and their blood pressure is still uncontrolled, they are deemed resistant.[7–9] Resistant hypertension is the term used to describe hypertension that must be treated with four or more drugs. The risk of heart attack, stroke, and renal failure is significantly increased by resistant hypertension.[7] Underlying medical issues including obesity, excessive alcohol use, or other drugs that might affect blood pressure are potential causes of resistant hypertension.[10] A complete physical examination and medical history are performed to diagnose resistant hypertension, and as a part of that process, the patient must disclose any current and past use of any prescription, over-the-counter, herbal, or recreational drugs or dietary supplements.[7] Most often, lifestyle counselling, medication, and surgery are used to treat resistant hypertension.[8] Patients with resistant hypertension need to take the right drugs in the right amounts at the right times, and they need to learn how to control their stress.[10]