Professor Carol Pollock .

Rachel Fieldhouse GPs can now prescribe finerenone under the PBS to prevent worsening kidney function in adults with chronic kidney disease caused by type 2 diabetes .

More than 26,000 patients with diabetic chronic kidney disease ( CKD ) who are still at risk of declining renal function despite first-line therapy are expected to benefit from the new listing , which went live on 1 July .

Eligible patients must have had

abnormal kidney structure or function for at least three months , an eGFR of ≥25mL / min / 1.73m3 and a urinary albumin-to-creatinine ratio of ≥200mg / g .

They should also be treated with an SGLT-2 inhibitor and a renin – angiotensin – aldosterone system blocker before starting on finerenone ( Kerendia ) unless medically contraindicated .

The recommended starting dose is 20mg once daily , but a lower 10mg dose is advised for those with an

eGFR below 60mL / min / 1.73m3 .

Sydney nephrologist Professor Carol Pollock said the listing was an “ excellent outcome ” for patients with progressive kidney disease at risk of renal replacement therapy .

But she urged GPs to be aware of the potential side effects associated with the mineralocorticoid receptor antagonist , including hyperkalaemia .

“ What I have tended to do in my own practice … is to check people ’ s serum potassium levels about

a month after they commence finerenone just to make sure that it is not increasing ,” she told Australian Doctor .

“ I would be a little bit wary of starting finerenone if the potassium level was above about 5.2mmol / L , although that is not evidence based .”

The product information advised clinicians to withhold finerenone if serum potassium exceeded 5.5mmol / L and restarting at 10mg once daily when it dropped below 5.0mmol / L .

Rachel Fieldhouse OVER-70s at high risk of cognitive impairment and dementia stand to benefit the most from hearing aid intervention , researchers report in a landmark trial .

They found that use of hearing aids for over three years was associated with a 48 % reduction in the rate of cognitive decline in high-risk adults but not among otherwise-healthy patients with a low dementia risk .

Lead author Professor Frank Lin , from John Hopkins University in Maryland , US , said results from the first-ofits-kind randomised trial provided “ compelling evidence ” for targeting hearing loss in dementia prevention .

The researchers assigned 977 patients ( mean age 77 ) with adult-onset bilateral hearing loss but no substantial cognitive impairment to receive hearing aids or a health education program , which acted as a control .

One in four were at high risk of dementia at baseline ; all participants underwent annual cognitive testing , including tests of executive function , memory and language .

The overall rate of cognitive decline was no different between those in the hearing aid intervention and control groups , but an additional pre-specified analysis showed a significant difference when comparing high- and low-risk patients .

Reporting in The Lancet , the authors also found a slower rate of cognitive decline among the healthier individuals , with no significant difference between the hearing aid and control groups .

This could be because these patients were slightly younger , had fewer risk factors and had higher cognition levels at baseline compared with the high-risk patients , they suggested . Lancet 2023 ; 17 Jul .