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

Ortiz A, Ferro CJ, Balafa O, Burnier M, Ekart R, Halimi JM, Kreutz R, Mark PB, Persu A, Rossignol P, Ruilope LM, Schmieder R, Valdivielso JM, Del Vecchio L, Zoccali C, Mallamaci F, Sarafidis P (2021)

Publication Type: Journal article

Publication year: 2021

Journal

DOI: 10.1093/ndt/gfab167

Abstract

Diabetic kidney disease (DKD) develops in similar to 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.

Authors with CRIS profile

Involved external institutions

University of Birmingham United Kingdom (GB) University Hospital of Ioannina / Panepistēmiakó Nosokomeío Iōannínōn / Πανεπιστημιακό Γενικό Νοσοκομείο Ιωαννίνων Greece (GR) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Maribor University Medical Centre (Maribor UMC) / Univerzitetni klinični center Maribor Slovenia (SI) François Rabelais University Tours France (FR) Charité - Universitätsmedizin Berlin Germany (DE) University of Glasgow United Kingdom (GB) European Centre for Clinical Research Training (ECCRT) Belgium (BE) Université de Lorraine France (FR) Research Institute Hospital 12 de Octubre (Imas12) Spain (ES) Institut de Recerca Biomèdica de Lleida (IRBLleida) Spain (ES) Azienda Socio Sanitaria Territoriale Lariana Italy (IT) Aristotle University of Thessaloniki Greece (GR) Fundación Jiménez Díaz Spain (ES) Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria Italy (IT)

How to cite

APA:

Ortiz, A., Ferro, C.J., Balafa, O., Burnier, M., Ekart, R., Halimi, J.-M.,... Sarafidis, P. (2021). Mineralocorticoid receptor antagonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfab167

MLA:

Ortiz, Alberto, et al. "Mineralocorticoid receptor antagonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease." Nephrology Dialysis Transplantation (2021).

BibTeX: Download