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Finerenone Potassium Threshold — ESENeph MCQ

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ModerateElectrolyte DisordersFinerenone Potassium ThresholdESENeph

A 55-year-old man with CKD G4 (eGFR 22 mL/min/1.73m2) has a serum potassium of 5.4 mmol/L. He is on Ramipril 10 mg and Dapagliflozin 10 mg. His clinician wants to add Finerenone. According to KDIGO 2024, what potassium threshold must be met before starting Finerenone?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Consistently normal serum potassium concentration before initiation

KDIGO 2024 practice point 3.8.3 states: to mitigate risk of hyperkalaemia, select people with consistently normal serum potassium concentration and monitor serum potassium regularly after initiation of a nonsteroidal MRA. In the FIDELIO and FIGARO trials, potassium had to be ≤4.8 mmol/L at randomisation. A potassium of 5.4 mmol/L would need to be corrected first (dietary measures, potassium binder if needed) before safely starting Finerenone.

Reference: KDIGO 2024 – CKD Guideline; FIDELIO-DKD/FIGARO-DKD