Finerenone shows promise as a kidney medication
At Empowered Kidney Care, we continue to pioneer a shift from reactive renal replacement (dialysis and transplant) to preventive kidney care. By moving upstream to preserve kidney function, we can help patients with chronic kidney disease (CKD) stay healthy and stay off dialysis altogether.
Successful CKD management depends largely on empowered patients and a collaborative healthcare team, but it also relies on the right tools: kidney medication options that preserve function and slow decline.
Recently, an exciting new drug called Finerenone has shown promising results in the preservation of kidney function for patients with early stage CKD through several clinical trials.
How can kidney medication help treat CKD?
Historically, kidney drugs have been notoriously underutilized, namely because emphasis has been placed on kidney failure and dialysis instead of preventative care.
Modern medicine has been aware of the kidney benefits of ACE and ARB inhibitors for over 20 years. We’ve observed drastic drop of new dialysis patients on USRDS data, credited to the use of ACE/ARBs, but today they are still prescribed to only half of CKD patients who need them.
Recently, SGLT-2 inhibitors have also shown tremendous promise for CKD, but they remain underutilized and cost-prohibitive for many patients. “SGLT-2s are diabetic tablets that turned out to be magnificent at preserving renal and cardiac function,” explains Dr. Richard Gibney, Empowered Kidney Care founder and practicing nephrologist at the University of Texas Health Science Center San Antonio. “We’re always looking for drugs that can do more than one thing at the same time.”
All of these systems are interconnected, and managing blood pressure and blood sugar helps prevent the kidneys from being over-stressed and further damaged.
How does Finerenone help improve kidney health?
“There is more than one component to progressive loss of kidney function for diabetics. There are different pathways that affect Kidney health,” explains Dr. Gibney.
“SGLT-2 Inhibitors change the atmosphere between the glomerulus and the tubules in the kidneys, the system of tiny blood vessels (capillaries) that work together to filter blood.
“Finerenone, on the other hand, is a mineralocorticoid receptor antagonist, which helps prevent kidney disease progression due to fibrosis and inflammation. This may be even more powerful in the fight against CKD.”
One recent study of over 13,000 patients showed that Finerenone reduced the risk of doubling creatinine by 23% (preserved kidney function) and increasing time to dialysis by 20%.
Since cardiovascular disease is also very prevalent in diabetic patients, Finerenone will likely benefit them through the same mechanism that prevents fibrosis and inflammation.
George L. Bakris, MD, a professor of medicine and the director of the American Heart Association-accredited Comprehensive Hypertension Center, University of Chicago Medicine praises these as “tremendous benefits” for kidney health: “If you use Finerenone in people at high cardiovascular risk and/or those [who] have diabetes and kidney disease, you are going to get significant renal benefit, not just in slowing progression … you are also going to get a benefit in terms of significant [increasing] in time to dialysis.”
No matter what, Dr. Gibney emphasizes that there is no one miracle drug for CKD, and ultimately, patients could end up on three primary medications. CKD treatment protocols will likely start at-risk patients on an ACE/ARB, add SGLT-2 for people with decreased function and/or proteinuria, then add Finerenone. “This is simply the latest step in our quest to identify the best kidney medication options to preserve function.”
Are new kidney medications safe?
As with any new drugs, doctors must continue to be cautious and monitor results and side effects.
SGLT-2 Inhibitors have recently come under scrutiny for risk of severe urinary tract infections (UTIs), but Dr. Gibney assures that the risks are manageable with the right safeguards in place: “Locally, we’ve created our own filters to make sure it’s safe. We don’t prescribe SGLT-2s to people with elevated risk or past history of UTIs … Over the past year we had two diabetic women who had UTIs, and we treated them with outpatient antibiotics and stopped SGLT-2s just to be safe. They are just fine.”
“Some people are also concerned that SGLT-2s actually decrease kidney function, but this is clearly not the case … Sometimes there will be a small GFR decrease right after a patient begins medication, but it stabilizes very quickly.”
A promising future for kidney medication
“This is an exciting time for both providers and patients,” says Dr. Gibney. “Without question, we believe if you take the right medications and you are involved in your care, you are going to see better results.”
Past studies have shown that up to 92% of CKD patients are unaware they have a decrease in kidney function. Even fewer patients are prescribed the right medications. With proper testing and CKD management, patients can preserve kidney function and avoid dialysis.
“Throughout this process, we’ve had tremendous support from the University Health System and medical school and their leadership,” Dr. Gibney adds. “This has been a great collaborative effort with many different parts of the medical system working together … We want to make sure every patient with CKD is aware of their issues and provided with quality treatment options.”
Especially if you have diabetes or hypertension (high blood pressure), talk to your primary care doctor, endocrinologist, or cardiologist about your lab work. If your data shows a loss of kidney function, ask them if medications like ACE/ARBS, SGLT-2s, or Finerenone can help you stay healthy.