Drop in Chronic Kidney Disease in Type 2 Diabetes seen with new drug

AMEDICAL expert is optimistic about the potential drop in the progression of Chronic Kidney Disease (CKD) in Type 2 Diabetes (T2D) cases in the country over the next five to 10 years.

Dr. Ronald Perez, the Head of Nephrology and Hemodialysis Unit at Capitol Medical Center, said during a press briefing at Bayer Philippines on April 23, 2024, that there is currently an annual estimated rise of 10 to 12 percent in chronic kidney disease patients who require dialysis. However, he expressed confidence in reducing this figure to 5 to 6 percent per annum with the introduction of the latest treatment approach for managing CKD in Type 2 Diabetes, known as Firenone (Firialta).

“I hope that we will be able to raise awareness that there is hope in decreasing or curbing the chronic kidney disease patients,” he said.

Dr. Perez emphasized the prospect of fewer patients requiring dialysis or kidney transplants.

“Although this is not a quick fix, but we will realize that in the next 10 years,” he said.

He also noted that this anticipated decline would alleviate the strain on the healthcare sector and the release Philhealth funds, allowing for increased allocation towards other healthcare resources.

Based on the 2023 Philhealth report, more than P17 billion is being spent to cover dialysis costs of Filipinos, which supports over three million dialysis claims.

Finerenone Study Highlights

DR. Perez presented the Fidelio (focuses on cardiovascular outcomes in patients with CKD and T2D) and Figaro (concentrates on renal outcomes in patients with CKD and T2D) trials.

A total of 13,000 patients were randomized globally, with around 6,000 in Fidelio and 7,500 in Figaro.

In terms of cardiovascular (CV) outcomes, Finerenone demonstrated a 14 percent reduced risk of CV morbidity and mortality compared to the placebo. This reduction in risk encompassed various events such as cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure.

Regarding kidney outcomes, the study assessed the time to kidney failure or a sustained decrease in estimated glomerular filtration rate (EGFR) of more than 57 percent from baseline, as well as kidneyrelated death. Patients treated with Finerenone showed a notable 23 percent decrease in EGFR, indicating a reduction in the progression to CKD and the need for dialysis.

The EGFR blood test is a measure of how well your kidneys are working. The EGFR is an estimated number based on a blood test and your age, sex and body type.

Furthermore, the study demonstrated a significant reduction in CKD progression with Finerenone treatment compared to placebo. Specifically, Finerenone led to a 32 percent decrease in the urinealbumin failure ratio between baseline and the end of the four-month treatment period.

Meanwhile, Dr. Perez’s patients, who participated in a medical trial conducted between 2015 and 2019 in The Medical City, faced challenges due to the limited availability of suitable candidates.

With ongoing trials globally, particularly in China, which had a significant population, the Philippines encountered difficulties in enrolling patients, especially those with chronic kidney disease stages 3 and 4.

Despite these enrollment challenges, patients who received the experimental drug experienced a notable 50 percent reduction in albuminuria, without any instances of dialysis initiation during the study.

However, there was a risk of increased serum potassium levels with the drug venerenone, necessitating careful monitoring due to the potential lethality of potassium to heart muscles.

Dr. Perez emphasized the critical importance of managing potassium levels, highlighting its lethal effects, akin to those in lethal injections where potassium chloride is administered. It is noted that no patients died during the trial period.

New treatment

HOWEVER, in 2021, statistics from the International Diabetes Federation revealed that 4.3 million Filipino adults are living with diabetes.

Research indicated that about one-third of adult patients with diabetes also experience CKD due to T2D, equating to roughly 1.43 million CKD patients.

Meanwhile, data from the National Kidney and Transplant Institute (NKTI) further illustrated that roughly one Filipino develops chronic renal failure every hour, contributing to an estimated 7 million Filipinos grappling with CKD.

Bayer Philippines Medical Director of Pharmaceutical Carmela Luisa Pagunsan emphasized that this newest treatment pillar, when integrated with the current standard of care, represents a significant step towards slowing down the progression of CKD. This, in turn, alleviates the burden on patients and their families who are already grappling with various physical, emotional, and financial challenges associated with multiple complications.

When Businessmirror asked about the possibility of combining Firenone with other medications for CKD management, given that CKD often arises from hypertension and diabetes, it was confirmed that such a combination is feasible.

Firenone, being a non-steroidal mineralocorticoid receptor antagonist, has been researched for its ability to mitigate inflammation and fibrosis in the kidneys, thereby reducing the risk of kidney failure. Patients can concurrently use medications for hypertension and diabetes alongside Firenone.

Precautionary Measures

WHEN Businessmirror asked about the precautions with the administration of the firenone, Dr. Perez outlined the monitoring of serum creatinine levels and ensuring patient protection.

If serum creatinine levels increase by more than 30 percent, clinicians should consider discontinuing finerenone.

Additionally, potassium levels should not exceed 4.8 millimoles per liter. Exceeding these levels necessitates stopping the drug and observing for two weeks before potential re-administration.

Persistent elevation suggests advanced diabetic kidney disease, rendering the drug ineffective.

Limit fruit intake

REGARDING dietary interactions, Perez advised limiting fruit intake due to potassium concerns and suggested reducing protein consumption to 0.8 grams per kilogram of body weight, approximately equivalent to two matchbox-sized servings of pork or beef, one drumstick of chicken, or one pound of fish per meal.

Dr. Perez further added that while he does not discourage the use of herbal medicine and holds no bias against them, he does caution against their indiscriminate combination.

His concern lies in the potential interactions between various herbal remedies when combined into a single concoction or drug, which can exacerbate side effects or nullify their intended benefits.

On the other hand, Pagunsan, further emphasized the importance of avoiding regular use of over-thecounter pills, as many of them can be toxic to the kidneys. Specifically, she warned against the use of Nonsteroidal Anti-inflammatory Drugs (NSAIDS), a type of pain reliever commonly known for its potential kidney toxicity.