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Finerenone in Diabetic CKD — EECC MCQ

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ModerateHypertension & Preventive CardiologyFinerenone in Diabetic CKDEECC

A 48-year-old woman with type 2 diabetes, hypertension, and eGFR 45 mL/min is started on finerenone. What is the mechanism of finerenone and its cardiovascular benefit?

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Correct answer: C — Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA) that reduces cardiovascular events and kidney disease progression in diabetic CKD, with lower risk of hyperkalaemia and gynaecomastia than steroidal MRAs

Finerenone is a novel non-steroidal MRA with higher selectivity for the mineralocorticoid receptor and a more favourable side-effect profile compared with steroidal MRAs (spironolactone, eplerenone). The FIDELIO-DKD and FIGARO-DKD trials (pooled in FIDELITY) demonstrated that finerenone significantly reduces the composite of cardiovascular death, MI, stroke, and HF hospitalisation, as well as kidney disease progression, in patients with type 2 diabetes and CKD. It has a lower risk of hyperkalaemia (though monitoring is still required) and does not cause gynaecomastia. It is positioned alongside SGLT2 inhibitors in cardiorenal protection strategies and is included in the 2024 ESC Hypertension Guidelines.

Reference: ESC (2024): Hypertension Guidelines; FIDELIO-DKD/FIGARO-DKD Trials