Potassium Management in CKD and Type 2 Diabetes Mellitus

Patients with type 2 diabetes mellitus and chronic kidney disease (CKD) face increased risk of progression of CKD and cardiovascular events. The risk is substantial despite treatment with renin-angiotensin system inhibitors and sodium-glucose cotransport 2 inhibitors. According to Alberto Ortiz, MD, and colleagues, there is preclinical and clinical evidence supporting the key role of mineralocorticoid receptor in cardiorenal injury in patients with type 2 diabetes.

In Expert Review of Clinical Pharmacology [doi:10.1080/17512433.2023.2213888] the researchers provided an overview of the risk factors for severe adverse events related to hyperkalemia as well as management of serum potassium levels in patients with CKD and type 2 diabetes treated with finerenone.

Finerenone is a selective and nonsteroidal mineralocorticoid receptor antagonist that has been shown in preclinical studies to reduce heart and kidney inflammation and fibrosis. Results of clinical trials have suggested that finerenone reduces progression of CKD and the risk of cardiovascular events in patients with CKD and type 2 diabetes. The incidence of adverse events was similar to that of placebo.

The rate of study drug discontinuation was low (1.7% of the finerenone group and 0.6% of the placebo group). The risk of severe adverse events related to hyperkalemia was also low.

The researchers said, “As finerenone increases potassium levels in a predictable way, patients at risk of hyperkalemia can be identified early in clinical practice and monitored for an easy management. This will allow people with type 2 diabetes mellitus and CKD to safely benefit from improved cardiorenal outcomes.”