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Journal Articles Nephrology Dialysis Transplantation Year : 2023

Mineralocorticoid receptor antagonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease

1 UAM - Universidad Autónoma de Madrid
2 University Hospitals Birmingham [Birmingham, Royaume-Uni]
3 University of Birmingham [Birmingham]
4 University Hospital of Ioannina
5 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
6 UKC Maribor - University medical centre Maribor
7 Hôpital Bretonneau
8 UT - Université de Tours
9 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
10 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
11 BIH - Berlin Institute of Health
12 HU Berlin - Humboldt-Universität zu Berlin = Humboldt University of Berlin = Université Humboldt de Berlin
13 Institute of Cardiovascular and Medical Sciences [Glasgow]
14 UCL - Université Catholique de Louvain = Catholic University of Louvain
15 IREC - Institut de Recherche Expérimentale et Clinique
16 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
17 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
18 Hospital Universitario 12 de Octubre [Madrid]
19 Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12
20 UEM - Universidad Europea de Madrid = European University of Madrid
21 Universitätsklinikum Erlangen [Erlangen]
22 IRBLleida - Biomedical Research Institute of Lleida [Spain]
23 Department of Nephrology and Dialysis, ASST Lariana
24 CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hpertension Unit, Reggio Calabria
25 Ospedali Riuniti
26 Aristotle University of Thessaloniki
27 Hippokration Hospital
Alberto Ortiz

Abstract

Diabetic kidney disease (DKD) develops in ∼40% of patients with diabetes and is the most common cause of chronic kidney disease (CKD) worldwide. Patients with CKD, especially those with diabetes mellitus, are at high risk of both developing kidney failure and cardiovascular (CV) death. The use of renin–angiotensin system (RAS) blockers to reduce the incidence of kidney failure in patients with DKD dates back to studies that are now ≥20 years old. During the last few years, sodium–glucose co-transporter-2 inhibitors (SGLT2is) have shown beneficial renal effects in randomized trials. However, even in response to combined treatment with RAS blockers and SGLT2is, the renal residual risk remains high with kidney failure only deferred, but not avoided. The risk of CV death also remains high even with optimal current treatment. Steroidal mineralocorticoid receptor antagonists (MRAs) reduce albuminuria and surrogate markers of CV disease in patients already on optimal therapy. However, their use has been curtailed by the significant risk of hyperkalaemia. In the FInerenone in reducing kiDnEy faiLure and dIsease prOgression in DKD (FIDELIO-DKD) study comparing the actions of the non-steroidal MRA finerenone with placebo, finerenone reduced the progression of DKD and the incidence of CV events, with a relatively safe adverse event profile. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of MRAs, analyses the potential mechanisms involved and discusses their potential future place in the treatment of patients with diabetic CKD.
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Dates and versions

hal-04023445 , version 1 (10-03-2023)

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Alberto Ortiz, Charles J Ferro, Olga Balafa, Michel Burnier, Robert Ekart, et al.. Mineralocorticoid receptor antagonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease. Nephrology Dialysis Transplantation, 2023, 38 (1), pp.10-25. ⟨10.1093/ndt/gfab167⟩. ⟨hal-04023445⟩
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