Evolution of Mineralocorticoid Receptor Antagonists in the Treatment of Chronic Kidney Disease Associated with Type 2 Diabetes Mellitus.
Mayo Clin Proc Innov Qual Outcomes
; 6(6): 536-551, 2022 Dec.
Article
em En
| MEDLINE
| ID: mdl-36277502
ABSTRACT
Chronic kidney disease (CKD) is one of the most frequent complications associated with type 2 diabetes mellitus (T2DM) and is also an independent risk factor for cardiovascular disease. The mineralocorticoid receptor (MR) is a nuclear receptor expressed in many tissue types, including kidney and heart. Aberrant and long-term activation of MR by aldosterone in patients with T2DM triggers detrimental effects (eg, inflammation and fibrosis) in these tissues. The suppression of aldosterone at the early stage of T2DM has been a therapeutic strategy for patients with T2DM-associated CKD. Although patients have been treated with renin-angiotensin system (RAS) blockers for decades, RAS blockers alone are not sufficient to prevent CKD progression. Steroidal MR antagonists (MRAs) have been used in combination with RAS blockers; however, undesired adverse effects have restricted their usage, prompting the development of nonsteroidal MRAs with better target specificity and safety profiles. Recently conducted studies, Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) and Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD), have reported that finerenone, a nonsteroidal MRA, improves both renal and cardiovascular outcomes compared with placebo. In this article, we review the history of MRA development and discuss the possibility of its combination with other treatment options, such as sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and potassium binders for patients with T2DM-associated CKD.
ACEi, angiotensin-converting enzyme inhibitor; ADA, American Diabetes Association; AR, androgen receptor; ARB, angiotensin II receptor blocker; ARTS, minerAlocorticoid Receptor Antagonist Tolerability Study; BP, blood pressure; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; DM, diabetes mellitus; DN, diabetic nephropathy; ESKD, end-stage kidney disease; FIDELIO-DKD, Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease; FIGARO-DKD, Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease; GLP-1 RA, glucagon-like peptide 1 receptor agonists; GR, glucocorticoid receptor; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; KDIGO, Kidney Disease Improving Global Outcomes; MR, mineralocorticoid receptor; MRA, mineralocorticoid receptor antagonist; PR, progesterone receptor; RAAS, reninangiotensinaldosterone system; RAS, reninangiotensin system; SGLT-2i, sodium-glucose cotransporter 2 inhibitor; T2DM, type 2 diabetes mellitus; UACR, urinary albumin-creatine ratio; eGFR, estimated glomerular filtration rate
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1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Risk_factors_studies
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article