Abstract
Diabetic kidney disease (DKD) is a major cause of end-stage kidney disease (ESKD) worldwide. Mineralocorticoid receptor (MR) plays an important role in the development of DKD. A series of preclinical studies revealed that MR is overactivated under diabetic conditions, resulting in promoting inflammatory and fibrotic process in the kidney. Clinical studies demonstrated the usefulness of MR antagonists (MRAs), such as spironolactone and eplerenone, on DKD. However, concerns regarding their selectivity for MR and hyperkalemia have remained for these steroidal MRAs. Recently, nonsteroidal MRAs, including finerenone, have been developed. These agents are highly selective and have potent anti-inflammatory and anti-fibrotic properties with a low risk of hyperkalemia. We herein review the current knowledge and future perspectives of MRAs in DKD treatment.
Highlights
Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease (ESKD) (Tuttle et al, 2014) and clarifying the precise mechanisms responsible for DKD is becoming an urgent problem worldwide
Unlike SGLT2 inhibitors and incretinbased drugs, the dose of nonsteroidal MR antagonists (MRAs) can be adjusted for renoprotection without considering glucose-lowering effects in patients with DKD, which may be advantage of nonsteroidal MRAs
The advent of nonsteroidal MRAs has revolutionized the treatment for DKD
Summary
Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease (ESKD) (Tuttle et al, 2014) and clarifying the precise mechanisms responsible for DKD is becoming an urgent problem worldwide. Esteghamati et al reported that 18-months administration of spironolactone (25 mg daily) plus losartan (50–100 mg daily) was more effective in reducing albuminuria in DKD patients than the dual combination of ACEis and ARBs (Esteghamati et al, 2013).
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