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Finerenone Monitoring — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseFinerenone MonitoringESENeph

A 45-year-old man with type 2 diabetes and CKD G3b has persistent proteinuria (uACR 95 mg/mmol) despite maximum Ramipril 10 mg and Dapagliflozin 10 mg. He has just started Finerenone 10 mg. What monitoring is required?

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Reveal the answer and explanation

Correct answer: C — Serum potassium and eGFR within 4 weeks of initiation and regularly thereafter

Finerenone can cause hyperkalaemia and an initial eGFR dip (similar to RASi). KDIGO 2024 recommends selecting patients with consistently normal potassium and monitoring potassium and eGFR regularly after initiation (typically within 2-4 weeks, then periodically). The FIDELIO-DKD and FIGARO-DKD trials used potassium monitoring at 1 and 4 weeks, then 4-monthly. Finerenone should be withheld if potassium rises above 5.5 mmol/L and restarted at lower dose once normalised.

Reference: KDIGO 2024 – CKD Guideline; FIDELIO-DKD Trial Protocol