How does Kerendia work in your body? Learn the mechanism of action explained simply, how long it takes, and what makes it unique.
Kerendia (Finerenone) works by blocking mineralocorticoid receptors in your kidneys and heart, which reduces the inflammation and scarring that chronic kidney disease and diabetes cause over time.
To understand how Kerendia works, it helps to understand the problem it's solving.
When you have chronic kidney disease (CKD) and type 2 diabetes, your body overactivates something called the mineralocorticoid receptor (MR) pathway. Think of mineralocorticoid receptors as tiny switches inside your kidney and heart cells. Normally, these switches help regulate salt, water, and blood pressure. But in CKD and diabetes, they get stuck in the "on" position — and that causes chronic inflammation and fibrosis (scarring).
Over time, this scarring damages your kidneys and heart. Your kidneys lose their ability to filter waste. Your heart muscle gets stiffer and works less efficiently. It's a slow, progressive process that leads to kidney failure and cardiovascular events like heart attacks and heart failure.
Kerendia — the brand name for Finerenone — is a non-steroidal mineralocorticoid receptor antagonist (MRA). Here's what that means in plain English:
Think of it like this: if your kidneys and heart are a house, and the MR pathway is a leaky pipe causing water damage (inflammation and scarring), Kerendia is the plumber that shuts off the leak — without accidentally flooding another room the way older medications sometimes do.
Kerendia starts working in your body relatively quickly — it reaches peak blood levels within about 0.5 to 1.5 hours after you take it. However, the clinical benefits — slowing kidney decline and reducing cardiovascular risk — happen gradually over months to years.
This is important to understand: Kerendia isn't a medication where you "feel" it working right away. You won't notice your kidneys getting better on a day-to-day basis. The benefits show up in your lab results (stable or improving eGFR, stable potassium) and in reduced risk of major events over time. In the FIDELIO-DKD and FIGARO-DKD clinical trials, significant differences in kidney and cardiovascular outcomes were seen over a median follow-up of about 2.6 to 3.4 years.
Your doctor will monitor your progress with regular blood tests, checking your potassium levels and kidney function. To learn more about what monitoring looks like, see our guide on Kerendia side effects and monitoring.
Kerendia has a relatively short half-life of about 2 to 3 hours. However, because of how it binds to the mineralocorticoid receptor, its protective effects last long enough that once-daily dosing is effective. You take it once a day, with or without food, at the same time each day.
If you miss a dose, take it as soon as you remember on the same day. If it's already close to your next dose, skip the missed one — don't double up.
Kerendia isn't the only MRA out there. Here's how it compares to the alternatives:
Spironolactone is a steroidal MRA that's been around for decades. It's available as a cheap generic and is widely used for heart failure, high blood pressure, and fluid retention. However, because it's steroidal, it cross-reacts with androgen and progesterone receptors, leading to side effects like gynecomastia (breast tissue growth in men), sexual dysfunction, and menstrual irregularities. Spironolactone is also not FDA-approved for CKD with type 2 diabetes.
Eplerenone is another steroidal MRA with better selectivity than Spironolactone — it causes fewer hormonal side effects. It's available as a generic and is primarily used for heart failure and hypertension. Like Spironolactone, it's not specifically approved for CKD with diabetes.
Dapagliflozin (Farxiga) and Empagliflozin (Jardiance) are SGLT2 inhibitors that also protect the kidneys and heart. They work through a completely different mechanism — they block glucose reabsorption in the kidneys, which also has protective effects on kidney function and cardiovascular health. Kerendia and SGLT2 inhibitors are sometimes used together for maximum protection. See our alternatives to Kerendia article for more options.
Kerendia works by targeting the root cause of kidney and heart damage in CKD and diabetes — overactive mineralocorticoid receptors that drive inflammation and scarring. It does this without the hormonal side effects of older steroidal MRAs. While you won't feel it working day to day, the clinical evidence shows meaningful protection over time.
If you'd like to learn more about Kerendia, check out our guides on what Kerendia is and Kerendia drug interactions. And when you're ready to fill your prescription, Medfinder can help you find it in stock near you.
You focus on staying healthy. We'll handle the rest.
Try Medfinder Concierge FreeMedfinder's mission is to ensure every patient gets access to the medications they need. We believe this begins with trustworthy information. Our core values guide everything we do, including the standards that shape the accuracy, transparency, and quality of our content. We’re committed to delivering information that’s evidence-based, regularly updated, and easy to understand. For more details on our editorial process, see here.
%2C%20Color%3DOriginal.png)
