Keywords: DKD, Rural Health

Background:

Diabetic Kidney Disease (DKD) is a common long-term macrovascular complication associated with diabetes, with around 30% of individuals with diabetes experiencing some degree of DKD during their lifetime. The standard approach to managing DKD includes a combination of RAAS blockade and SGLT2 inhibitors. However, the persistence of residual risk has led to the recent endorsement of Finerenone, a non-steroidal mineralocorticoid receptor antagonist, as a valuable third option in the treatment of DKD. Finerenone enhances outcomes for DKD patients by attenuating inflammation and fibrosis in both the kidneys and heart, resulting in a slower progression of kidney disease, decreased albuminuria, and a reduction in cardiovascular events. It presents a safer alternative compared to traditional MRAs and has now been integrated into guideline-based therapy for patients with DKD and albuminuria.

Aim of the case report:

The case series aims to optimise the management of DKD in patients in a rural primary care setting by following a three-pillared approach.

Case report:

117 out of our 602-patient diabetes register were found to have a degree of chronic kidney disease. Of these 117 patients, 38 were eligible for initiation with Finerenone following its licensing indication. Through the review process, 28 out of the eligible 38 patients were initiated with Finerenone (73.6%), 71.4% of these being male.

Conclusions:

Finerenone plays a crucial role in the management of diabetic kidney disease (DKD), providing significant benefits in slowing the progression of kidney damage. Its use alongside other therapies, such as ACEi/ARBs, SGLT2 inhibitors, combined with lifestyle modifications, is essential for optimising patient care, potentially increasing renal longevity. In rural settings, where access to renal replacement therapy is limited, ensuring that patients receive timely and effective treatments is crucial for improving long-term disease outcomes.