Management Strategies for Potassium Levels During Non-steroidal Mineralocorticoid Receptor Antagonist Therapy: A Comprehensive Review.

Abstract

Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease (CKD). Recent advancements highlight the role of finerenone, a non-steroidal mineralocorticoid receptor antagonist (nsMRA), in DKD management. Studies like FIDELIO-DKD, FIGARO-DKD, and FIDELITY have demonstrated finerenone's efficacy in reducing CKD progression and cardiovascular risks in DKD patients. Trials reveal higher incidence of hyperkalemia in finerenone groups compared to controls. Asian populations are noted to have a higher risk, emphasizing the need for close monitoring. To manage hyperkalemia, evidence-based protocols suggested starting finerenone with potassium level below 4.8mEq/L, discontinuing if potassium level exceed 5.5mEq/L. Strategies include dietary potassium restriction, potassium binders, and frequent monitoring. While these managements help mitigate risks, real-word challenges call for further evidence to refine practical guidelines. Finerenone emerges as a promising therapy for DKD but requires careful management to prevent hyperkalemia, ensuring optimal patient outcomes.