Reno-protective Effect Of Mineralocorticoid Receptor Antagonist Esaxerenone

Abstract

Background The implications of mineralocorticoid receptor antagonists, including a newly-introduced esaxerenone, on renal function remains uncertain. Methods We retrospectively included the patients who received esaxerenone for resistant hypertension between Nov 2019 and Jun 2020. The trends of estimated glomerular filtration ratio (eGFR) were compared between the six-month pre-treatment period (without esaxerenone) and the six-month treatment period (on esaxerenone). Results Twenty-six patients (70 [51, 73] years old, 15 men, systolic blood pressure 146 [139, 156] mmHg) were included and completed 6-month esaxerenone therapy without any adverse events. eGFR decreased significantly during the pre-treatment period (from 66.6 down to 59.5 mL/min/1.73m2, p = 0.003), whereas eGFR remained unchanged during the treatment period (from 59.5 to 61.8 mL/min/1.73m2, p = 0.15; Figure 1A). A median change in eGFR was significantly higher in the treatment period compared to the pre-treatment period (3.8 [-4.2, 6.8] versus -6.1 [-11.1, 1.8] mL/min/1.73m2, p = 0.008; Figure 1B). Conclusions Esaxerenone may have reno-protective effect when administered to treat hypertension. Further studies are needed to understand which patient populations may see greater reno-protective benefits. The implications of mineralocorticoid receptor antagonists, including a newly-introduced esaxerenone, on renal function remains uncertain. We retrospectively included the patients who received esaxerenone for resistant hypertension between Nov 2019 and Jun 2020. The trends of estimated glomerular filtration ratio (eGFR) were compared between the six-month pre-treatment period (without esaxerenone) and the six-month treatment period (on esaxerenone). Twenty-six patients (70 [51, 73] years old, 15 men, systolic blood pressure 146 [139, 156] mmHg) were included and completed 6-month esaxerenone therapy without any adverse events. eGFR decreased significantly during the pre-treatment period (from 66.6 down to 59.5 mL/min/1.73m2, p = 0.003), whereas eGFR remained unchanged during the treatment period (from 59.5 to 61.8 mL/min/1.73m2, p = 0.15; Figure 1A). A median change in eGFR was significantly higher in the treatment period compared to the pre-treatment period (3.8 [-4.2, 6.8] versus -6.1 [-11.1, 1.8] mL/min/1.73m2, p = 0.008; Figure 1B). Esaxerenone may have reno-protective effect when administered to treat hypertension. Further studies are needed to understand which patient populations may see greater reno-protective benefits.