Addressing Cardiovascular Risk in CKD Patients

Author(s):

Anuradha Lala-Trindade, MD,Edgar Lerma, MD

Key Takeaways

Finerenone, approved in 2021, reduces risks of eGFR decline, kidney failure, and cardiovascular events in CKD with type 2 diabetes.
The FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF trials underscore finerenone's cardio-renal benefits.
KDIGO guidelines endorse a 4-pillar approach: Metformin, ACE inhibitors/ARBs, SGLT2 inhibitors, and finerenone for diabetic kidney disease management.
Primary care providers play a crucial role in early identification and intervention for at-risk patients.

In part 3 of this 5-part series, Lerma discusses recent updates in the management of chronic kidney disease in people with type 2 diabetes.

EP: 1.Exploring the Interplay Between Chronic Kidney Disease and Cardiovascular Disease

EP: 2.Understanding the Effects of nsMRA vs MRA

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EP: 3.Addressing Cardiovascular Risk in CKD Patients

EP: 4.Applying Recent Guidelines, 4-Pillared Approach to CKD Care

EP: 5.Exploring the Cardiovascular Benefits, Potential of Finerenone

Management of chronic kidney disease among patients with type 2 diabetes has undergone significant change in the last decade. Once handcuffed by a lack of safe and efficacious options, changing standards of care coming as the result of pharmacotherapeutic advancement have ushered in a new era of management for this patient population.

This change has been spearheaded by 2 particular classes—a familiar face in the form of SGLT2 inhibitors and the novel nonsteroidal mineralocorticoid receptor antagonist (nsMRA) finerenone (Kerendia), which received approval in July 2021 for reducing the risk of sustained eGFR decline, kidney failure, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease associated with type 2 diabetes.

Finerenone first captivated the attention of nephrologists, endocrinologists, and other providers managing patients with type 2 diabetes with the release of data from the FIDELIO-DKD and FIGARO-DKD trials. The number of specialists captivated by the agent and its potential benefit grew with the release of data surrounding the cardiovascular benefits among patients with heart failure observed within the FINEARTS-HF trial at the European Society of Cardiology Congress 2024.

In this segment, which is part 3 of a 5-part series, discussants Edgar Lerma, MD, a nephrologist, and Anuradha Lala-Trindade, MD, a cardiologist, delve into the updated clinical guidelines for managing chronic kidney disease (CKD), especially among patients with type 2 diabetes and elevated cardiovascular risk. Lerma emphasizes the KDIGO guidelines, which now endorse finerenone as an effective treatment option following results from the FIDELIO and FIGARO studies.

He outlines the modern 4-pillar approach to managing diabetic kidney disease, which includes Metformin, ACE inhibitors or ARBs, SGLT2 inhibitors, and finerenone. Each drug offers unique cardio-renal benefits, working through different mechanisms to slow chronic kidney disease progression and reduce complications. Lerma also stresses the essential role of primary care providers as first responders in identifying at-risk patients, fostering early intervention with this comprehensive, multi-disciplinary approach.

Discussants Background:

Edgar Lerma, MD, a clinical professor of Medicine in the Section of Nephrology at the University of Illinois at Chicago and a nephrologist with Associates In Nephrology based in Chicago.

Anuradha Lala-Trindade, MD, the director of Heart Failure Research, program director of the Advanced Heart Failure and Transplant Fellowship, and associate professor of Medicine at The Mount Sinai Fuster Heart Hospital & Department of Population Health Science and Policy.

Relevant disclosures for Lerma include Akebia, Astra Zeneca, Bayer, Boehringer Ingelheim, Glaxo Smith Kline, Otsuka, Travere, Vifor, and Fresenius. Relevant disclosures for Lala-Trindade include Merck, AstraZeneca, Cytokinetics, and Novartis.

References:

Campbell P. Finerenone (Kerendia) approved for chronic kidney disease associated with type 2 diabetes. HCP Live. July 9, 2021. Accessed October 23, 2024. https://www.hcplive.com/view/finerenone-kerendia-approved-chronic-kidney-disease-associated-with-type-2-diabetes.
Campbell P. FDA updates Finerenone label to reflect Cardiovascular Outcomes Data. HCP Live. September 8, 2022. Accessed October 23, 2024. https://www.hcplive.com/view/fda-updates-finerenone-label-to-reflect-cardiovascular-outcomes-data.
Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. Published online September 1, 2024. doi:10.1056/NEJMoa2407107