The new Era of non-Steroidal Mineralocorticoid Antagonists in Treating Heart Failure in Diabetic Kidney Disease Patients.

Abstract

Inappropriate activation of the mineralocorticoid receptor (MR) plays a significant role in developing hypertension, the development of cardiac pathological changes, and chronic kidney disease (CKD), where death related to cardiovascular (CV) causes is the primary competing for the outcome to the progress to end-stage renal disease (ESRD) in patients with CKD.
 Congestive heart failure (CHF) is a frequent comorbidity in patients with CKD. MR overactivation within the heart might cause coronary endothelial dysfunction, myocardial apoptosis, and reactive myocardial fibrosis and thus contribute to cardiac remodeling and its adverse consequences.
 MR antagonists (MRAs) are evidence-based therapy in symptomatic patients with heart failure and reduced ejection fraction (HFrEF).
 Finerenone, a novel, nonsteroidal, selective mineralocorticoid receptor antagonist (MRA) with anti-inflammatory and antifibrotic effects, is a promising tool in treating heart failure in patients with T2DM and CKD.
 It is felt to have higher potency and less hyperkalemia than steroidal MRAs such as spironolactone and eplerenone. It is unclear and a matter of discussion if it could be first-line therapy in this group of patients.
 Conclusion: Nonsteroidal MRAs are currently tested in clinical trials. Based on preclinical and first clinical data, these nonsteroidal MRAs might overcome the limitations of today's steroidal antagonists.