Do you continue finerenone in a patient with CKD and type 1 diabetes whose eGFR has fallen 35% one month after starting 10 mg, if potassium is normal and UACR is falling?
At what percentage drop in eGFR from baseline to week 4 would you consider holding finerenone in a patient with CKD and type 1 diabetes who has normal potassium and a falling UACR?
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Yes, I would often continue finerenone but recheck creatinine and eGFR in another month or so to make sure the change in GFR has leveled off. This will also depend a bit on what the baseline eGFR is; the higher the baseline eGFR, the more likely I am to let this change go for another month.
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Generally speaking, if the decline in eGFR is >30%, then a reasonable approach is to recheck the GFR and, if it has stabilized, then to observe/follow according to clinical judgement, while at the same time making sure BP is NOT low and that the patient is not volume depleted (and making adjustments...
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A dip in eGFR is expected at 1-3 months with finerenone. I would continue it and follow the patient closely.
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