Finerenone: A Potential Treatment for Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus.

TouchREVIEWS in endocrinology Pub Date : 2021-11-01 Epub Date: 2021-11-10 DOI:10.17925/EE.2021.17.2.84
Luis D'Marco, María Jesús Puchades, Lorena Gandía, Claudia Forquet, Elena Giménez-Civera, Nayara Panizo, Javier Reque, Isabel Juan-García, Valmore Bermúdez, José Luis Gorriz
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Abstract

Type 2 diabetes mellitus (T2DM) affects an estimated 463 million people worldwide, equivalent to 1 in 11 adults. Moreover, the rapid growth of this disease has resulted in a high incidence of diabetic kidney disease (DKD), which, together with hypertension, is the main cause of chronic kidney disease (CKD). Hyperglycaemia, low-grade inflammation, altered lipid metabolism and hyperactivation of the renin-angiotensin-aldosterone system (RAAS) seem to be interrelated mechanisms contributing to both T2DM and microvascular complications. The introduction of drugs such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists has improved the ability to slow the progression of DKD, and has also demonstrated benefits in cardiovascular disease. Beyond the effects of these novel antidiabetic drugs, a body of evidence suggests that the overactivation of the mineralocorticoid receptor also contributes to CKD progression. Moreover, new and ongoing trials have demonstrated that the selective nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone improves the risk of CKD progression and cardiovascular events in patients with CKD and T2DM and optimized RAAS blockade. We review the rationale for the development and use of MRA drugs to slow CKD progression in patients with DKD, as well as other pleiotropic effects, and highlight the warnings associated with these agents.

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非格列酮慢性肾病和 2 型糖尿病患者的潜在治疗方法。
全世界约有 4.63 亿人患有 2 型糖尿病(T2DM),相当于每 11 个成年人中就有 1 人。此外,这种疾病的快速增长导致糖尿病肾病(DKD)的高发病率,而糖尿病肾病与高血压一起,是慢性肾病(CKD)的主要病因。高血糖、低度炎症、脂质代谢改变和肾素-血管紧张素-醛固酮系统(RAAS)亢进似乎是导致 T2DM 和微血管并发症的相互关联的机制。钠-葡萄糖共转运体 2 抑制剂和胰高血糖素样肽 1 受体激动剂等药物的问世,提高了延缓 DKD 病程进展的能力,也显示出对心血管疾病的益处。除了这些新型抗糖尿病药物的作用外,大量证据表明,矿物质皮质激素受体的过度激活也是导致慢性肾脏病进展的原因之一。此外,新的和正在进行的试验表明,选择性非甾体类矿化皮质激素受体拮抗剂(MRA)非那西酮可改善慢性肾功能衰竭和 T2DM 患者的慢性肾功能衰竭进展风险和心血管事件,并优化 RAAS 阻断。我们回顾了开发和使用 MRA 药物以延缓 DKD 患者 CKD 病程进展的理论依据以及其他多生物效应,并强调了与这些药物相关的警告。
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