Freely Filtered, a NephJC Podcast Freely Filtered 028: Finerenone for diabetic kidney disease
Dec 25, 2020
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Rigorous Run-In To Maximize Background Therapy
- The trial used an extended run-in to maximize ACEi/ARB dosing rather than just requiring a stable dose.
- Ensuring true background renin-angiotensin blockade clarified finerenone's incremental effect on outcomes.
Use Conservative Baseline Potassium Cutoffs
- Start trials with a conservative potassium threshold (K <4.8) when testing MR antagonists in CKD to reduce severe hyperkalemia.
- Monitor potassium closely and exclude high‑risk patients to limit early serious events.
Meaningful Kidney Benefit Over 2.6 Years
- Finerenone reduced the primary renal composite by 18% with an absolute risk reduction of 3.4% over 2.6 years.
- The treatment effect equates to an NNT of about 29 over the trial duration, with likely improved benefit over longer use.