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Potassium management with finerenone: Practical aspects

INTRODUCTION: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has favourable effects on cardiorenal outcomes in patients with mild‐to‐severe chronic kidney disease with increased albuminuria and type 2 diabetes. METHODS: Two large, randomized trials have evaluated the eff...

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Autores principales: Wanner, Christoph, Fioretto, Paola, Kovesdy, Csaba P., Malyszko, Jolanta, Pecoits‐Filho, Roberto, Schnell, Oliver, Rossignol, Patrick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9659654/
https://www.ncbi.nlm.nih.gov/pubmed/36574588
http://dx.doi.org/10.1002/edm2.360
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author Wanner, Christoph
Fioretto, Paola
Kovesdy, Csaba P.
Malyszko, Jolanta
Pecoits‐Filho, Roberto
Schnell, Oliver
Rossignol, Patrick
author_facet Wanner, Christoph
Fioretto, Paola
Kovesdy, Csaba P.
Malyszko, Jolanta
Pecoits‐Filho, Roberto
Schnell, Oliver
Rossignol, Patrick
author_sort Wanner, Christoph
collection PubMed
description INTRODUCTION: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has favourable effects on cardiorenal outcomes in patients with mild‐to‐severe chronic kidney disease with increased albuminuria and type 2 diabetes. METHODS: Two large, randomized trials have evaluated the effects of finerenone on clinical outcomes. The first trial (FIDELIO‐DKD) investigated renal outcomes, and the second (FIGARO‐DKD) cardiovascular outcomes. RESULTS: Patients in the two studies had a high intrinsic risk of hyperkalemia due to type 2 diabetes, treatment with optimized doses of an inhibitor of the renin‐angiotensin system, and, in some patients, their advanced chronic kidney disease. This was reflected in the incidence of hyperkalemia in the placebo group during the trials. Patients on finerenone had a significantly higher incidence of hyperkalemia compared with patients on placebo, but treatment discontinuation due to hyperkalemia was low, and no patients experienced death attributable to hyperkalemia. Structured routine potassium monitoring with temporary treatment interruption and dose reduction, as used in the two trials, should ensure the safe use of finerenone to protect the kidneys and cardiovascular system of patients with albuminuric chronic kidney disease and type 2 diabetes. CONCLUSIONS: The aim of this document is to highlight the routine potassium management required when using finerenone and to provide practical recommendations.
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spelling pubmed-96596542022-11-14 Potassium management with finerenone: Practical aspects Wanner, Christoph Fioretto, Paola Kovesdy, Csaba P. Malyszko, Jolanta Pecoits‐Filho, Roberto Schnell, Oliver Rossignol, Patrick Endocrinol Diabetes Metab Research Article INTRODUCTION: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has favourable effects on cardiorenal outcomes in patients with mild‐to‐severe chronic kidney disease with increased albuminuria and type 2 diabetes. METHODS: Two large, randomized trials have evaluated the effects of finerenone on clinical outcomes. The first trial (FIDELIO‐DKD) investigated renal outcomes, and the second (FIGARO‐DKD) cardiovascular outcomes. RESULTS: Patients in the two studies had a high intrinsic risk of hyperkalemia due to type 2 diabetes, treatment with optimized doses of an inhibitor of the renin‐angiotensin system, and, in some patients, their advanced chronic kidney disease. This was reflected in the incidence of hyperkalemia in the placebo group during the trials. Patients on finerenone had a significantly higher incidence of hyperkalemia compared with patients on placebo, but treatment discontinuation due to hyperkalemia was low, and no patients experienced death attributable to hyperkalemia. Structured routine potassium monitoring with temporary treatment interruption and dose reduction, as used in the two trials, should ensure the safe use of finerenone to protect the kidneys and cardiovascular system of patients with albuminuric chronic kidney disease and type 2 diabetes. CONCLUSIONS: The aim of this document is to highlight the routine potassium management required when using finerenone and to provide practical recommendations. John Wiley and Sons Inc. 2022-09-15 /pmc/articles/PMC9659654/ /pubmed/36574588 http://dx.doi.org/10.1002/edm2.360 Text en © 2022 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Wanner, Christoph
Fioretto, Paola
Kovesdy, Csaba P.
Malyszko, Jolanta
Pecoits‐Filho, Roberto
Schnell, Oliver
Rossignol, Patrick
Potassium management with finerenone: Practical aspects
title Potassium management with finerenone: Practical aspects
title_full Potassium management with finerenone: Practical aspects
title_fullStr Potassium management with finerenone: Practical aspects
title_full_unstemmed Potassium management with finerenone: Practical aspects
title_short Potassium management with finerenone: Practical aspects
title_sort potassium management with finerenone: practical aspects
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9659654/
https://www.ncbi.nlm.nih.gov/pubmed/36574588
http://dx.doi.org/10.1002/edm2.360
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