Abstract
Diabetes mellitus is a global health issue and main cause of chronic kidney disease. Both diseases are also linked through high cardiovascular morbidity and mortality. Diabetic kidney disease (DKD) is present in up to 40% of diabetic patients; therefore, prevention and treatment of DKD are of utmost importance. Much research has been dedicated to the optimization of DKD treatment. In the last few years, mineralocorticoid receptor antagonists (MRA) have experienced a renaissance in this field with the development of non-steroidal MRA. Steroidal MRA have known cardiorenal benefits, but their use is limited by side effects, especially hyperkalemia. Non-steroidal MRA still block the damaging effects of mineralocorticoid receptor overactivation (extracellular fluid volume expansion, inflammation, fibrosis), but with fewer side effects (hormonal, hyperkalemia) than steroidal MRA. This review article summarizes the current knowledge and newer research conducted on MRA in DKD.
Highlights
The first meta-analysis looking at the role of spironolactone and eplerenone in chronic kidney disease patients already treated with renin–angiotensin system (RAS) inhibitors showed that mineralocorticoid receptor antagonists (MRA) reduce proteinuria and increase the risk of hyperkalemia [55]
In 2016, Beygui et al (Aldosterone Lethal effects Blocked in Acute myocardial infarction Treated with or without Reperfusion to improve Outcome and Survival at Six months follow-up (ALBATROSS) trial) could not show the advantage of MRA
MRA have a role in diabetic kidney disease (DKD) in lowering albuminuria
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. MRA were first used in clinical trials in cardiovascular diseases, especially in patients with heart failure Later, their role in chronic kidney disease evolved. The first meta-analysis looking at the role of spironolactone and eplerenone in chronic kidney disease patients already treated with RAS inhibitors showed that MRA reduce proteinuria and increase the risk of hyperkalemia [55]. In the latest meta-analysis, the use of MRA (spironolactone, eplerenone, finerenone) alone or on top of RAS inhibitors had a significant antiproteinuric effect in chronic kidney disease patients [56]. MRA decreased UACR by 24.6%, urine protein–creatinine ratio by 53.9% and 24 h albuminuria by 32.5% All this is likely to be clinically relevant since >30% albuminuria reduction in comparison to placebo has been shown to reduce the risk of end-stage kidney disease development [57].
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