Finerenone in mildly reduced or preserved ejection fraction and chronic kidney disease: a narrative review

BACKGROUND: In patients with type 2 diabetes and chronic kidney disease (CKD) heart failure with preserved ejection fraction is associated with considerable morbidity and it has fewer treatment options available. HFpEF, which is characterized by increased cardiovascular risks and poor outcomes, continues to be a therapeutic challenge, particularly in older persons. MAIN BODY: A non-steroidal mineralocorticoid receptor antagonist (MRA), finerenone has excellent therapeutic potential in patients with HFpEF and CKD, notably those with diabetes type 2. Research indicate that Finerenone preferentially targets mineralocorticoid receptors associated with inflammation and fibrosis and that it also has an advantage over commonly used steroidal MRAs (e.g., spironolactone), which carry significant risks such as hyperkalemia, gynecomastia, and renal impairment. There are two phase 3 clinical trials namely FIDELIO-DKD and FIGARO-DKD demonstrating how effectively finerenone works in preventing the progression of renal damage and cardiovascular events in type 2 diabetic patients and in patients with CKD. In addition, the FINEARTS-HF study shows that hospitalizations for heart failure were reduced with use of finerenone and also the overall decline in individuals with HFpEF across all ages, particularly the older populations. Finally, Finerenone is found to be more appropriate for patients with complex medical histories because its safety profile shows fewer side effects compared to the traditional steroidal MRAs, as it has lower risks for electrolyte imbalances and renal function deterioration. CONCLUSION: This article addresses the safety, efficacy, mechanism of action, and various trials conducted on Finerenone and how it gained importance as an effective substitute in the management of HFpEF and CKD, decreasing morbidity and mortality risks while limiting adverse effects.