Which patients is suitable for Finerenone? Clinical Application Guide

Finerenone (Finerenone) is a new type of non-steroidal selective aldosterone receptor antagonist (MRA), mainly used for chronic kidney disease (CKD) combined with type 2 diabetes (T2DM). Compared with traditional MRAsuch as spironolactone and eplerenone, fenelinone has better selectivity and lower incidence of adverse reactions, so it is clinically recommended for specific high-risk groups.

Fenelidone is particularly suitable for patients with chronic kidney disease combined with type 2 diabetes, especially those who already have proteinuria and whose eGFR is still 25ml/min/1.73m² or above. According to the results of the large studies of FIDELIO-DKD and FIGARO-DKD, fenelidone can significantly reduce the risk of renal function deterioration and cardiovascular events, and has therefore been included in many international clinical guidelines. For patients who cannot effectively control proteinuria after using RAAS inhibitors (such as ACEI or ARB), the addition of fenelidone may be considered.

When selecting patients, attention should be paid to the risk of hyperkalemia with fenelidone. Although the risk is lower than that of spironolactone, serum potassium levels need to be monitored closely before starting treatment and during the initial period of treatment. It is generally not recommended to start use if the serum potassium ≥5.0 mmol/L is used. If the serum potassium rises to 5.5 mmol/L or more during treatment, use should be suspended until it returns to normal. Patients who are already at risk for hyperkalemia (such as severe renal impairment, concomitant use of other potassium-raising drugs) need to be carefully evaluated.

Finelidone is not suitable for patients with heart failure without diabetes, and its efficacy has not been widely proven in people with early-stage kidney disease without diabetes. In addition, since its metabolism is mainly through the liver CYP3A4 pathway, it is not recommended to use it in combination with strong CYP3A4 inhibitors (such as ketoconazole, clarithromycin, etc.) to avoid increasing drug blood concentrations and causing adverse reactions. In summary, fenelidone is a precise treatment drug for people with diabetic nephropathy. Under the premise of reasonable selection and strict monitoring, it can significantly improve the prognosis of heart and kidneys.

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