Watch Dr Brunton
and Dr Wright discuss
a patient case
Patients with progressing CKD associated with T2D need your help at every stage of their journey
Works full time and has an active social life. He was diagnosed with T2D 8 years ago, which has led to CKD.
Declining eGFR:58 mL/min/1.73 m2
Microalbuminuria*
Current therapy: Taking multiple T2D
standard-of-care medications,† including
an optimized dose of an ARB
*Microalbuminuria can be defined as "moderately increased" with a UACR of 30-300 mg/g.5
†In the FIDELIO-DKD trial, approximately 97% of patients were on an antidiabetic medication
(insulin [64.1%], biguanides [44%], GLP-1 receptor agonists [7%] and/or SGLT2 inhibitor [5%]).
Background therapies were similar in the FIGARO-DKD trial.4
Works full time and has an active social life. He was diagnosed with T2D 8 years ago, which has led to CKD.
Declining eGFR:58 mL/min/1.73 m2
Microalbuminuria*
Current therapy: Taking multiple T2D standard-of-care medications,† including an optimized dose of an ARB
*Microalbuminuria can be defined as "moderately
increased" with a UACR of 30-300 mg/g.5
†In the FIDELIO-DKD trial, approximately 97% of patients
were on an antidiabetic medication (insulin [64.1%],
biguanides [44%], GLP -1 receptor agonists [7%] and/or
SGLT2 inhibitor [5%]). Background therapies were
similar in the FIGARO-DKD trial.4
Risk of CKD progression based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013; 3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Risk of CKD progression based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
eGFR categories: eGFR ≥90 mL/min/1.73 m2=normal or high (G1); eGFR 60–89 mL/min/1.73 m2=mildly decreased (G2); eGFR 45–59 mL/min/1.73 m2=mildly to moderately decreased (G3a); eGFR 30–44 mL/min/1.73 m2= moderately to severely decreased (G3b); eGFR 15–29 mL/min/1.73 m2=severely decreased (G4); eGFR <15 mL/min/1.73 m2=kidney failure (G5).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013; 3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Former smoker who had an MI 2 years ago. He was diagnosed with T2D 10 years ago, which has led to his recent diagnosis of CKD.
eGFR:57 mL/min/1.73 m2
Albuminuria/UACR:360 mg/g
BP and HbA1c:Treated for individualized goal
Serum potassium: 4.2 mEq/L
Current therapy: Maximum tolerated
labeled dose of an ACEi, T2D standard of care,*
aspirin monotherapy, and a statin
*In the FIDELIO-DKD trial, approximately 97% of patients were on an antidiabetic medication (insulin [64.1%], biguanides [44%], GLP-1 receptor agonists [7%], and/or SGLT2 inhibitors [5%]). Background therapies were similar in the FIGARO-DKD trial4
Former smoker who had an MI 2 years ago. He was diagnosed with T2D 10 years ago, which has led to his recent diagnosis of CKD.
eGFR: 57 mL/min/1.73 m2
Albuminuria/UACR: 360 mg/g
BP and HbA1c: Treated for individualized goal
Serum potassium: 4.2 mEq/L
Current therapy: Maximum tolerated labeled dose of an ACEi, T2D standard of care,* aspirin monotherapy, and a statin
*In the FIDELIO-DKD trial, approximately 97% of patients
were on an antidiabetic medication (insulin [64.1%],
biguanides [44%], GLP-1 receptor agonists [7%], and/or
SGLT2 inhibitors [5%]). Background therapies were
similar in the FIGARO-DKD trial4
Risk of CV mortality based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013;3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Risk of CV mortality based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013; 3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Risk of CKD progression based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013; 3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Risk of CKD progression based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
eGFR categories: eGFR ≥90 mL/min/1.73 m2=normal or high (G1); eGFR 60–89 mL/min/1.73 m2=mildly decreased (G2); eGFR 45–59 mL/min/1.73 m2=mildly to moderately decreased (G3a); eGFR 30–44 mL/min/1.73 m2= moderately to severely decreased (G3b); eGFR 15–29 mL/min/1.73 m2=severely decreased (G4); eGFR <15 mL/min/1.73 m2=kidney failure (G5).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013; 3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Full-time social worker who enjoys watching musicals with her husband and granddaughter. She has been diagnosed with CKD associated with T2D.
Declining eGFR:44 mL/min/1.73 m2
Albuminuria/UACR: >300 mg/g
Current therapy: T2D standard of care,*
maximum tolerated dose of an ARB
*In the FIDELIO-DKD trial, approximately 97% of patients were on an antidiabetic medication
(insulin [64.1%], biguanides [44%], GLP-1 receptor agonists [7%], and/or SGLT2 inhibitors [5%]).
Background therapies were similar in the FIGARO-DKD trial.4
Full-time social worker who enjoys watching musicals with her husband and granddaughter. She has been diagnosed with CKD associated with T2D.
Declining eGFR:44 mL/min/1.73 m2
Albuminuria/UACR:>300 mg/g
Current therapy: T2D standard of care,* maximum tolerated dose of an ARB
*In the FIDELIO-DKD trial, approximately 97% of patients
were on an antidiabetic medication (insulin [64.1%],
biguanides [44%], GLP-1 receptor agonists [7%], and/or
SGLT2 inhibitors [5%]). Background therapies were
similar in the FIGARO-DKD trial.4
Risk of CKD progression based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013;3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Risk of CKD progression based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
eGFR categories: eGFR ≥90 mL/min/1.73 m2=normal or high (G1); eGFR 60–89 mL/min/1.73 m2=mildly decreased (G2); eGFR 45–59 mL/min/1.73 m2=mildly to moderately decreased (G3a); eGFR 30–44 mL/min/1.73 m2= moderately to severely decreased (G3b); eGFR 15–29 mL/min/1.73 m2=severely decreased (G4); eGFR <15 mL/min/1.73 m2=kidney failure (G5).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013;3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
Risk of CV mortality based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013;3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
† Based on the 2005 double-blind placebo-controlled FIELD trial of 200 mg once-daily micronized fenofibrate or placebo in 9795 patients with T2D and mild dyslipidemia. Patients with macroalbuminuria and eGFR 30 to 59 mL/min/1.73 m2 had ~5x greater risk of CV death than patients with no albuminuria and eGFR ≥90 mL/min/1.73 m2.6
Risk of CV mortality based on eGFR and albuminuria categories (green=low to no risk; yellow=moderately increased risk; orange=high risk; red=very high risk).
Adapted with permission from KDIGO. Levey AS, de Jong PE, Coresh J, et al. Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2013;3(1):63-72. Accessed: https://www.kisupplements.org/article/S2157-1716(15)31102-3/fulltext
† Based on the 2005 double-blind placebo-controlled FIELD trial of 200 mg once-daily micronized fenofibrate or placebo in 9795 patients with T2D and mild dyslipidemia. Patients with macroalbuminuria and eGFR 30 to 59 mL/min/1.73 m2 had ~5x greater risk of CV death than patients with no albuminuria and eGFR ≥90 mL/min/1.73 m2.6
ACEi=angiotensin-converting enzyme inhibitor; ACR=albumin-to-creatinine ratio; ARB=angiotensin receptor blocker; BP=blood pressure; CKD=chronic kidney disease; CV=cardiovascular; eGFR=estimated glomerular filtration rate; GLP-1=glucagon-like peptide-1; HbA1c=glycated hemoglobin; KDIGO=Kidney Disease: Improving Global Outcomes; MI=myocardial infarction; MOA=mechanism of action; MOD=mechanism of disease; SGLT2=sodium-glucose cotransporter 2; T2D=type 2 diabetes; UACR=urine albumin-to-creatinine ratio.
KERENDIA is indicated to reduce the
risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D)
Measure serum potassium periodically during treatment with KERENDIA and adjust dose accordingly. More frequent monitoring may be necessary for patients at risk for hyperkalemia, including those on concomitant medications that impair potassium excretion or increase serum potassium
Please read the Prescribing Information for KERENDIA.
References: 1. Afkarian M, et al. J Am Soc Nephrol. 2013;24(2):302-308. doi:10.1681/ASN.2012070718. 2. Bailey RA, et al. BMC Res Notes. 2014;7:415. doi:10.1186/1756-0500-7-415. 3. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. Kidney Int. 2020;98(4S):S1-S115. doi:10.1016/j.kint.2020.06.019. 4. KERENDIA (finerenone) [prescribing information]. Whippany, NJ: Bayer HealthCare Pharmaceuticals, Inc.; September 2022. 5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Kidney Intl Suppl. 2013;3(1):1-150. doi:10.1038/kisup.2012.73. 6. Drury PL, et al. Diabetologia. 2011;54(1):32-43. doi:10.1007/s00125-010-1854-1.