Finerenone Slows Chronic Kidney Disease Progression Precisely
Most chronic kidney disease (CKD) is caused by diabetes, high blood pressure, and aging itself. CKD is increasing steadily in our overweight, aging population. We once thought that CKD is relentlessly progressive once established and that we were unable to delay dialysis. Fortunately, new understandings of the biology that causes CKD makes it possible to delay and slow that terrible illness.
New research related to a single medication, finerenone, shows that it lowers the risk of progression to dialysis by 20% in patients with type 2 diabetes and CKD. There were 13,206 patients followed for 3 years in this population. Finerenone was associated with a 23% reduction in risk of the composite kidney outcome (hazard ratio [HR], 0.77 P=.0002), with consistent benefits observed across baseline subgroups for kidney function and protein in the urine. Finerenone causes fewer problems with high potassium and binds to the MR receptor better than eplerenone.
Finerenone is a mineralocorticoid receptor (MR) antagonist. Look in the upper right corner of the diagram. Finerenone may be substituted for spironolactone and eplerenone in the green box and blocks MR activation which interferes with excess oxidant production and the mechanisms downstream that damage the kidney. It is a precision medicine.
So, where does finerenone fit? The average retail price for finerenone is over $700 a month. That is $8400 a year. It is very expensive. Finerenone can be used later in CKD and it is safer. Spironolactone is $4 a month. The average retail price of eplerenone is $120 and with a coupon can be found for just over $30. The older generic medications are much less expensive and if used earlier in disease in lower doses can provide good protection at very low cost. Use the less expensive meds early in disease to delay the day the higher cost medication is needed.