Impact of Diabetes on Kidney Health

Chronic kidney disease (CKD) is a prevalent complication among individuals diagnosed with diabetes, serving as an independent risk factor for cardiovascular diseases. Recent insights shared at a professional training event highlighted the significant connection between diabetes and kidney health.

According to a presentation by a hospital pharmacist from the University Medical Center Hamburg-Eppendorf, approximately 30 to 40 percent of people with diabetes will develop diabetic nephropathy--a kidney condition that stems from diabetes--during their lifetime. This condition is the leading cause of kidney failure and the necessity for dialysis.

The progression of diabetic nephropathy can often go unnoticed for years. Initially, the kidneys respond to elevated blood sugar levels by enhancing the reabsorption of ions from the primary urine, effectively increasing their filtration capability as a compensatory mechanism. However, over time, the disease deteriorates, leading to further damage to the nephrons and a decline in filtration performance, which can be detected through increased albumin excretion (microalbuminuria). Without intervention, this can escalate into chronic kidney disease characterized by substantial albumin loss and significant hypertension, often manifested by symptoms like headaches and dizziness.

To preserve kidney function, it is crucial to optimally manage blood pressure levels. Moreover, blood sugar control is equally important. Despite adhering to established treatment guidelines, inflammatory and fibrotic processes within the kidneys may persist. Since 2022, Finerenone (Kerendia®), a medication approved for chronic kidney disease in diabetic patients, has been introduced to complement ACE inhibitors or angiotensin receptor blockers (ARBs). Finerenone acts as a selective antagonist of the mineralocorticoid receptor (MR), which is activated by hormones such as aldosterone and cortisol. By binding to the MR, Finerenone reduces the expression of inflammatory and profibrotic signaling molecules, aiming to prevent renal and cardiovascular events--an outcome supported by substantial clinical studies, including the Phase III FIDELIO-DKD trial.

The FIDELIO-DKD study, which involved over 56,000 participants suffering from chronic kidney disease and Type 2 diabetes, demonstrated that Finerenone significantly lowers the risk of disease progression and the occurrence of cardiovascular complications when compared to a placebo. The medication is also recommended in cardiology guidelines for the prevention of heart failure in diabetic individuals with chronic kidney disease.