Diabetics are to be offered a daily pill that slashes their risk of developing life-threatening kidney and heart complications.
The high sugar levels in diabetes can damage blood vessels in the kidneys. When this happens, toxins cannot be filtered out of the blood, putting strain on the heart.
Last week, NHS Scotland spending watchdogs approved a tablet, finerenone, for type 2 diabetes patients living with kidney disease. And experts say health chiefs are to offer the drug to type 2 diabetics in England and Wales.
A decision on NHS funding of finerenone, which costs £17 per pill, is due next month and charities say approval would benefit up to 1.5 million diabetic Britons, who are either living with kidney disease or expected to develop it in the future.
A decision on NHS funding of finerenone, which costs £17 per pill, is due next month and charities say approval would benefit up to 1.5 million diabetic Britons, who are either living with kidney disease or expected to develop it in the future
‘This drug has the exciting potential to substantially improve the care of patients with chronic kidney disease due to diabetes,’ says Dr Graham Lipkin, a trustee of Kidney Care UK. ‘It should have a sizeable benefit to patients and help them to avoid the need for more intensive hospital treatments.’
About 4.4 million Britons have type 2 diabetes, a condition that occurs when blood sugar is too high – often because of genetics, obesity and lack of exercise.
This imbalance can trigger a number of complications, including damaging the blood vessels in the kidneys. This harms the kidneys, but it can also cause them to produce a hormone called aldosterone. Studies show that excess levels of this hormone can scar the kidneys – causing irreversible damage – and heightens the risk of heart disease.
Roughly 40 per cent of type 2 diabetics will develop kidney disease at some point.
In a worldwide trial of more than 5,500 adults with kidney disease associated with type 2 diabetes, participants took the drug every day. The results, published last year in the New England Journal of Medicine, found that those who took finerenone were about a fifth less likely to die of kidney failure compared to type 2 diabetes patients not taking the drug
‘These conditions go hand-in-hand,’ says kidney doctor Dr Kieran McCafferty, a consultant nephrologist at Barts Health NHS Trust in London. ‘I spend most of my time trying to prevent heart disease. If you have diabetic kidney disease, you’re more likely to die of heart disease than kidney failure. So it’s very important that we have effective treatments for these patients that can treat both.’
Drugs capable of inhibiting aldosterone have been available on the NHS for two decades but have been given sparingly as they can trigger an irregular heartbeat, which in turn can lead to heart failure.
Finerenone, also known as Kerendia, also limits the amount of aldosterone the body makes.
However, studies show it is far safer than previous drugs, meaning it is unlikely to have any heart complications.
In a worldwide trial of more than 5,500 adults with kidney disease associated with type 2 diabetes, participants took the drug every day. The results, published last year in the New England Journal of Medicine, found that those who took finerenone were about a fifth less likely to die of kidney failure compared to type 2 diabetes patients not taking the drug.
The trial also found that finerenone reduced the risk of death or hospitalisation with heart failure by 14 per cent after two-and-a-half years. Researchers believe the long-term benefit of finerenone could be even greater. They estimate that taking the pill every day reduces the risk of kidney failure by as much as 40 per cent, which will cut hospitalisation and deaths.
‘This is a really exciting drug,’ says Dr McCafferty. ‘It’s safe and keeps patients out of hospital. Hopefully this evidence is enough for NICE [the National Institute for Health and Care Excellence] to fund the drug.’
He adds: ‘The next step will be to offer the treatment to kidney disease patients who don’t have diabetes – meaning that many more Britons could one day benefit.’
One patient to benefit from finerenone is Anthony Price, 67, from Birmingham.The retired entrepreneur has lived with type 2 diabetes for more than 30 years and was diagnosed with early-stage kidney disease just over a decade ago.
His consultant offered him the chance to join the finerenone trial. ‘If my kidneys got worse then I could end up on dialysis or need a transplant, and I very much didn’t want to do either,’ says Anthony.
‘This drug was an added level of security against kidney disease, alongside the important task of paying attention to my blood sugars to keep my diabetes in check.’
For three years, Anthony took the pill every morning with breakfast. He says he experienced no side effects. What’s more, he has suffered no kidney or heart disease complications.
‘I hope I get put back on it when it’s approved,’ he says.
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