Key takeaways:
Kerendia (finerenone) is a prescription medication used to treat chronic kidney disease (CKD), specifically in adults with Type 2 diabetes. It can also be used to manage heart failure in adults with or without diabetes.
Common Kerendia side effects include high potassium levels, low blood pressure, and low sodium levels. It may also contribute to uric acid increases and changes to kidney function test results.
Kerendia may rarely cause more serious side effects, such as chest pain, fainting, or hallucinations. Your prescriber should regularly monitor your blood work, kidney function tests, and blood pressure to prevent serious side effects from occurring.
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High blood glucose (sugar) from Type 2 diabetes can cause damage to your kidneys. This damage makes it harder for your kidneys to function. Over time, this can lead to chronic kidney disease (CKD), where your kidneys stop working as well as they should. Thankfully, there is a medication available to protect your kidney health.
Kerendia (finerenone) is a prescription medication that’s FDA-approved to treat CKD, specifically in adults with Type 2 diabetes. It's also approved to treat certain types of heart failure in adults with or without diabetes. It’s a mineralocorticoid receptor antagonist (MRA) that works by blocking a hormone called aldosterone.
High levels of aldosterone can cause inflammation in your kidneys, blood vessels, and heart. In fact, people with CKD tend to have too much aldosterone in their body compared with people without kidney problems. But, aldosterone also plays a role in balancing your electrolytes and blood pressure. Kerendia side effects can occur because of this.
Kerendia side effects at a glance
Here’s a summary of the side effects reported during Kerendia’s initial clinical trials. But keep in mind that other side effects may occur, too. Be sure to speak with your prescriber about any side effects you’re concerned about while taking Kerendia.
Common Kerendia side effects include:
High potassium levels
Low blood pressure
Low sodium levels
High uric acid levels
Changes in results from estimated glomerular filtration rate (eGFR), a kidney function test
Below, we’ll review these five Kerendia side effects and how to manage them.
1. High potassium
High blood levels of potassium (hyperkalemia) was the most common Kerendia side effect in clinical trials. This is because Kerendia can prevent potassium loss through your urine.
Mild cases of hyperkalemia usually don’t cause any symptoms. But it’s important to be aware of possible signs of it. Symptoms of high potassium can include:
Muscle weakness
Confusion
Tingling
Numbness
Nausea and vomiting
Very high potassium levels can cause more life-threatening symptoms, such as irregular heartbeat, chest pain, or shortness of breath. If you’re experiencing any of these serious side effects, seek medical attention right away.
Managing hyperkalemia from Kerendia
It’s recommended to have blood tests to check your potassium levels (and eGFR) before starting Kerendia and regularly while you’re taking it. These will help your prescriber catch high potassium levels before they become dangerous. If your potassium levels are too high, your prescriber may change your Kerendia dose or have you stop taking it.
In addition to these blood tests, you may be asked to avoid taking potassium supplements or eating high quantities of potassium-rich foods, such as avocados. Furthermore, certain medications, such as lisinopril (Zestril), can also cause high potassium levels.
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Kerendia dosages: Use our comprehensive guide to predict what Kerendia dosage may be recommended by your prescriber.
Renal dosing for medications: Safe and effective Kerendia dosages are based on your kidney function. Learn more about renal dosing and when your dose could change.
Be sure to speak with your prescriber about your current medication list, diet, and any supplements you are taking. They can tell you if any adjustments are necessary, large or small.
2. Low blood pressure
Kerendia can cause very low blood pressure, also known as hypotension. This happens because Kerendia can make you pee more fluids, which lowers your blood volume.
Symptoms of low blood pressure can include:
Blurry vision
Dizziness
Confusion
Lightheadedness
Tiredness
Nausea
Speak with your prescriber if you experience any of these symptoms of low blood pressure. But if you’re feeling very faint, have someone take you to the nearest ER right away.
Fortunately, in clinical trials, most people's blood pressure normalized after taking Kerendia for about 1 month. Still, be sure to check your blood pressure regularly at home, and let your prescriber know if you’re taking any blood pressure-lowering medications.
3. Low sodium
As mentioned above, aldosterone normally balances electrolytes in your body — including sodium. By blocking aldosterone, Kerendia can cause sodium loss through your urine. This may result in low blood sodium levels (hyponatremia).
Symptoms of low sodium may include:
Dizziness
Headache
Weakness
Nausea and vomiting
Muscle cramps or spasms
Loss of appetite
As with your potassium levels, your prescriber will likely recommend regular blood tests to check your sodium levels. If your sodium level is low, your prescriber may recommend changing your diet or limiting how much water you drink.
However, if your levels are at risk of dropping too low, your prescriber may recommend taking a sodium supplement, changing your dose of Kerendia, or stopping it altogether. That’s because very low sodium levels can cause dangerous symptoms, such as hallucinations, confusion, and seizures.
4. Higher uric acid levels
Kerendia can cause higher levels of uric acid (hyperuricemia) in your blood. Uric acid is a waste product that your body makes when it breaks down purines found in food and drinks. High uric acid levels can lead to a condition called gout, where you have pain and swelling in your joints.
The risk of high uric acid is greater when you start taking Kerendia. But it usually goes down as you keep taking it.
Luckily, most people who developed high uric acid levels in Kerendia’s clinical trials did not have any symptoms. But, if you have a history of gout, it’s important to speak with your prescriber before starting Kerendia. They can help you monitor your uric acid and lower your risk of gout flare-ups.
5. Kidney lab work changes
Your prescriber should check your kidney function (eGFR) before starting you on Kerendia. Kidney function tests help your prescriber choose the right starting dose for you and make sure it’s safe for you to take.
After you start taking Kerendia, though, you might notice lower kidney function results within the first 4 weeks of beginning the prescription. This change is usually temporary and typically stabilizes as your body adjusts to the medication.
Does Kerendia make you pee more?
Yes. Kerendia can make you pee more. This is because Kerendia is an MRA that blocks aldosterone. Aldosterone manages the balance of water and salt in your body. By blocking aldosterone, Kerendia helps your body get rid of extra water through your urine.
The bottom line
Common Kerendia (finerenone) side effects include high potassium levels, low blood pressure, and low sodium levels. High uric acid levels and changes in kidney function test results are possible, too. More severe side effects — such as chest pain, fainting, and hallucinations — may occur, but they’re far less common.
Your prescriber should regularly monitor your blood work, blood pressure, and kidney labs to prevent any serious side effects. Speak with your prescriber or pharmacist if you have any questions about Kerendia side effects and how to manage them.
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References
American Heart Association. (2024). Low blood pressure – when blood pressure is too low.
Bayer HealthCare Pharmaceuticals Inc. (2025). Kerendia (finerenone) tablets, for oral use [package insert].
Bayer Inc. (2025). U.S. FDA approves Kerendia (finerenone) to treat patients with heart failure with left ventricular ejection fraction ≥40% following priority review.
Bayer Inc. (2022). Kerendia product monograph.
Belden, Z., et al. (2017). The role of the mineralocorticoid receptor in inflammation: Focus on kidney and vasculature. American Journal of Nephrology.
Centers for Disease Control and Prevention. (2024). Chronic kidney disease.
Kintscher, U., et al. (2023). The non-steroidal mineralocorticoid receptor antagonist finerenone and heart failure with preserved ejection fraction. Cardiovascular Diabetology.
Li, L., et al. (2020). Update on the epidemiology, genetics, and therapeutic options of hyperuricemia. American Journal of Translational Research.
Minakuchi, H., et al. (2020).The effect of aldosterone and aldosterone blockade on the progression of chronic kidney disease: A randomized placebo-controlled clinical trial. Scientific Reports.
National Kidney Foundation. (n.d.). Hyperkalemia (high potassium).
National Kidney Foundation. (2022). Estimated glomerular filtration rate (eGFR).
National Kidney Foundation. (2023). Hyponatremia (low sodium level in the blood).
