Title: Finerenone for treating chronic kidney disease in people with type 2 diabetes (ID3773)
Funder: Department of Health and Social Care

Abstract: Chronic kidney disease (CKD) is a condition where the kidneys do not work as well as they should[1] and is linked with adverse outcomes including cardiovascular disease[2]. It is common in people who have diabetes (where it is known as diabetic kidney disease) because people with diabetes have too much glucose in their blood, and this can damage the tiny filters in the kidneys[1]. People with CKD do not usually have symptoms during the early stages of the disease but symptoms including weight loss and poor appetite, swollen ankles, feet or hands, shortness of breath, tiredness, feeling sick and itchy skin can develop as the disease progresses[1]. The severity of CKD is determined by the estimated glomerular filtration rate (eGFR) of which there are 6 categories (normal, mild reduction, mild to moderate reduction, moderate to severe reduction, severe reduction and kidney failure) and albumin to creatinine ratio (ACR) with 3 categories (normal to mild increase, moderate increase and severe increase)[3]. An ACR of more than 3 mg/mmol is an indicator for albuminuria, when urine protein levels are increased, resulting from damage within the kidneys[3]._x000D_ _x000D_ Approximately 3 million people are currently diagnosed with type 2 diabetes in England[4]. Around 20% of people with diabetes will need treatment for kidney disease during their lifetime and at least 10,350 people in the UK have end-stage kidney failure caused by diabetes[5]. More than 1 in 3 people who need kidney dialysis, or a transplant have diabetes[5]. End-stage renal disease is associated with significant impact on quality of life for people with the condition and their families and diabetes with early kidney involvement may be associated with shorter life expectancy[6]._x000D_ _x000D_ Lifestyle changes are usually recommended for people with kidney disease, including stopping smoking, eating a healthy diet and regular exercise. There is no medicine specifically for CKD, but treatment can help control many of the associated problems such as high blood pressure, high cholesterol and anaemia[1]. For people with CKD and diabetes, NICE clinical guideline 182 ‘chronic kidney disease in adults: assessment and management’ recommends aiming to keep systolic blood pressure below 130 mmHg (target range 120–129 mmHg) and the diastolic blood pressure below 80 mmHg. To control blood pressure, CG182 recommends a drug that blocks or inhibits the renin-angiotensin system including angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs) and direct renin inhibitors if there is an ACR of 3 mg/mmol or more. People with severely reduced kidney function may need dialysis or a kidney transplant[1]._x000D_ _x000D_ 1. NHS - Chronic Kidney Disease; accessed April 2021._x000D_ 2. Levey et al. (2005) Kidney Disease: Improving Global Outcomes (KDIGO); Kidney International, 67 2089-2100_x000D_ 3. Kidney Research UK - Stages of Kidney Disease; accessed April 2021_x000D_ 4. Diabetes UK - Diabetes Prevalence 2019; accessed April 2021_x000D_ 5. Diabetes UK (2019) Us, diabetes and a lot of facts and stats. Accessed April 2021._x000D_ 6. Wen et al. (2017) Diabetes with early kidney involvement may shorten life expectancy by 16 years; Kidney International, 92 (2): 388-396

Lay abstract: To appraise the clinical and cost effectiveness of finerenone within its marketing authorisation for treating chronic kidney disease in people with type 2 diabetes.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: METABOLIC AND ENDOCRINE;RENAL AND UROGENITAL