Kerendia

Unlike older mineralocorticoid receptor blockers like spironolactone, Kerendia is a selective, non-steroidal agent specifically designed for diabetic kidney disease. It’s taken orally as 10mg or 20mg tablets once daily with or without food, though you must avoid grapefruit and grapefruit juice during treatment. The starting dose depends on your kidney function (measured by eGFR) and potassium levels, your doctor uses blood tests to determine whether you begin with 10mg or 20mg and adjusts after 4 weeks based on follow-up testing.

How Kerendia Protects Your Kidneys and Heart: In diabetic kidney disease, high blood sugar and blood pressure damage tiny kidney blood vessels over time, causing protein (albumin) to leak into urine and scarring that reduces kidney function. The hormone aldosterone worsens this damage by promoting inflammation and fibrosis (scarring) in both kidneys and heart tissue. Kerendia works by blocking mineralocorticoid receptors that aldosterone activates, preventing the harmful inflammatory and scarring processes that lead to kidney failure and cardiovascular events.

Major clinical trials (FIDELIO-DKD and FIGARO-DKD) involving over 13,000 patients showed Kerendia significantly reduced the risk of kidney failure, sustained decline in kidney function, cardiovascular death, non-fatal heart attacks, non-fatal strokes, and hospitalizations for heart failure. The medication also reduced protein in urine by about 31-32% at 4 months and maintained this reduction throughout the studies. Most patients noticed blood pressure dropped by 2-4 mm Hg, which provides additional cardiovascular protection.

Treatment Requirements: Before starting Kerendia, you need blood tests measuring serum potassium and eGFR (kidney filtration rate). You cannot start treatment if potassium is above 5.0 mmol/L or if your eGFR is below 25 mL/min/1.73 m². After starting, you’ll have repeat blood tests at 4 weeks to check potassium levels and kidney function, then periodically throughout treatment. Most patients can increase from the 10mg starting dose to the target 20mg dose after 4 weeks if blood tests are acceptable.

Kerendia must be used with maximum tolerated doses of ACE inhibitors or ARB medications (standard blood pressure drugs for diabetic kidney disease). You continue these medications while adding Kerendia for additional kidney and heart protection. Similar to patients using Jardiance or other SGLT2 inhibitors for diabetic kidney disease, Kerendia can be combined with multiple diabetes medications including metformin, insulin, and GLP-1 agonists.

Important Drug Interactions: Several medications increase Kerendia blood levels and raise the risk of high potassium. You cannot take Kerendia with strong CYP3A4 inhibitors like ketoconazole, itraconazole, clarithromycin, ritonavir, or nefazodone. Moderate CYP3A4 inhibitors like erythromycin and verapamil increase Kerendia levels but can be used with careful potassium monitoring. You should also avoid potassium-sparing diuretics (amiloride, triamterene), other mineralocorticoid receptor antagonists (spironolactone, eplerenone), and be cautious with potassium supplements.

If you need antibiotics like trimethoprim or trimethoprim/sulfamethoxazole (Bactrim), your doctor may temporarily stop Kerendia since these drugs increase potassium levels. Strong CYP3A4 inducers like rifampin, carbamazepine, phenytoin, and St. John’s Wort should be avoided because they decrease Kerendia effectiveness. For patients managing multiple conditions with medications from cardiovascular health categories, careful medication review prevents dangerous interactions.

Kerendia can be taken crushed and mixed with water or soft foods like applesauce if you have trouble swallowing tablets, this doesn’t affect how the medication works. Take it at the same time each day to maintain consistent blood levels. If you miss a dose, take it as soon as you remember that same day, but skip it if you remember the next day and just take your regular dose then. Never double up to make up for missed doses.