Innovation slows CKD progression in type-2 diabetes

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Jakarta, IO – Chronic kidney disease (CKD) is a condition characterized by chronic kidney function decline, and is diagnosed as progressive and irreversible. Treatment measures given to patients with chronic kidney disease depend on the stage of their illness and what may be obtained from treatment of comorbid conditions, ranging from renal replacement to hemodialysis. 

2018 Basic Health Research (Riskesdas) data reveals 3.8% occurrence of CKD in people aged over 15 years, numbering 739,208 for an increase of 2.3% from 2013. Meanwhile, IHME Global Burden of Disease 2019 data includes CKD as one of the top 10 causes of death. 

The latest innovation of what is known as “finerenone drug therapy” can slow kidney damage in type-2 diabetes patients where CKD complications are absent. Patients who undergo this additional therapy can enjoy better quality of life than they would by just taking the main drug. This was what emerged in the press conference, held by Bayer with the theme “Treatment Innovations for CKD Patients with Type-2 Diabetes” on Monday (15/1/2024). 

On this occasion, Chairman of the Indonesian Society of Nephrology (PB Pernefri) dr. Pinggodigdo Nugraho, Sp.PD-KGH, explained that finerenone functions as a mineralocorticoid receptor and thus forestalls the effects of inflammation and fibrosis, both of which cause permanent kidney damage. If the kidneys are damaged or fail, the Consultant Kidney and Hypertension Internal Medicine Specialist from Cipto Mangunkusumo Hospital, Jakarta, stated that the patient must undergo dialysis or even a kidney transplant. 

“Currently available therapy is only meant for hemodynamic and metabolic conditions, and not yet for inflammatory or fibrosis problems. The results of the finerenone test have anti-inflammatory and fibrosis effects in preclinical models, and are shown to reduce albuminuria in patients with CKD and type-2 diabetes. Finerenone inhibits kidney damage and the progression of CKD, not stopping it, and is known to have great benefits for prolonging life, improving quality of life, and preventing premature death. The cost of dialysis is expensive, it is hoped that this drug can reduce the economic burden on society and the country,” he said. 

It was revealed that in 2022, diabetic nephropathy or diabetic kidney disease ranked second (32%) as the cause of disease in stage 5 CKD patients. Research from the University of California in 2018 showed that CKD and type-2 diabetes patients have an increased risk of death from cardiovascular events six times higher compared to those without CKD or type-2 diabetes. 

Screening of UACR and eGFR 

The second speaker, Prof. Dr. dr. Ketut Suastika, Sp.PD-KEMD, an Internal Medicine Endocrinology, Diabetes, and Metabolic Disease Consultant from Udayana University, Denpasar, added that CKD in end-stage type-2 diabetes patients demands dialysis or a kidney transplant, an operation which may impair life expectancy by up to 16 years. In Indonesia, 60% of kidney failure sufferers have to undergo dialysis. 

It was revealed that with finerenone therapy, the patient’s quality of life could improve further. Based on research by the American Society of Nephrology (ASN) Kidney Week 2021, finerenone therapy can reduce the risk of CKD progression in type-2 diabetes patients and shows a reduction in the need for dialysis and kidney transplantation by up to 36%. 

Special attention is needed because 1 in 10 type-2 diabetes patients suffer CKD, and 9 out of 10 patients diagnosed with CKD are not aware of their condition. As a result, kidney damage continues without proper treatment. “We must be more proactive in carrying out CKD screening in type-2 diabetes patients. It is a good idea to do routine screening at least once a year,” observed Prof. Ketut. 

The American Diabetes Association (ADA), Kidney Disease: Improving Global Outcomes (KDIGO), and the European Society of Cardiology (ESC) have published guidelines recommending screening, using the urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), for at least once a year for all type-2 diabetes patients, regardless of treatment. An early sign of kidney disease in diabetes patients is increased production of albumin or protein in the urine. 

“Finerenone significantly reduces the level of albuminuria by 31% in 4 months, as well as cutting the estimated eGFR by 57%,” said dr. Dewi Muliatin Santoso, Head of Medical Department PT Bayer Indonesia. 

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Finerenone received a distribution permit in Indonesia last year and was only launched on January 15, 2024. Currently, this oral drug is starting to spread in a number of hospitals with a price range of IDR 20,000 to 24,000 per tablet, with doses of 10 and 20 milligrams (mg). 

At the end, dr. Pringgodigdo emphasized the importance of early detection, because CKD is generally asymptomatic. “If the urine is foamy, it’s too late. Therefore, we need to be alert if we experience itching because it is an early sign that the kidney’s function in filtering the body’s toxins has been disrupted. Other efforts include reducing salt intake and engaging in regular physical activity,” he explained. (est)