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Published in: Current Diabetes Reports 1/2019

01-01-2019 | Spironolactone | Microvascular Complications—Nephropathy (M Afkarian and B Roshanravan, Section Editors)

Mineralocorticoid Antagonism and Diabetic Kidney Disease

Authors: Yuliya Lytvyn, Lucas C. Godoy, Rosalie A. Scholtes, Daniël H. van Raalte, David Z. Cherney

Published in: Current Diabetes Reports | Issue 1/2019

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Abstract

Purpose of Review

Type 2 diabetes (T2D) is associated with an increased risk of diabetic kidney disease (DKD), cardiovascular disease, and heart failure, in part through activation of the renin-angiotensin-aldosterone system (RAAS). Although recent cardiovascular outcome trials have identified newer therapeutic agents such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1)-receptor agonists that reduce the risk of these complications, patients still exhibit residual cardiorenal morbidity and mortality. Accordingly, the identification of pharmacological agents that attenuate micro- and macrovascular complications related to T2D is a major priority. Our aim was to review evidence for the role of novel mineralocorticoid receptor antagonists (MRAs) that are being developed as adjunctive therapies to reduce the risk of DKD and cardiovascular disease in the setting of T2D.

Recent Findings

Dual RAAS blockade with angiotensin-converting enzyme (ACE) inhibitor plus angiotensin receptor blockade (ARB) or ARB plus renin inhibition increases serious adverse events such as acute kidney injury and stroke. Due to the potential for these serious side effects, more recent interest has focused on newer, more selective non-steroidal MRAs such as finerenone as cardiorenal protective therapies. Finerenone reduces albuminuria in the setting of DKD in patients with T2D and has a lower risk of hyperkalemia compared to currently available MRAs.

Summary

Novel MRAs such as finerenone have the potential to reduce the risk of DKD progression in patients with T2D. The impact of finerenone on hard, long-term cardiorenal endpoints is being examined in the FIGARO and FIDELIO trials in patients with DKD.
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Metadata
Title
Mineralocorticoid Antagonism and Diabetic Kidney Disease
Authors
Yuliya Lytvyn
Lucas C. Godoy
Rosalie A. Scholtes
Daniël H. van Raalte
David Z. Cherney
Publication date
01-01-2019
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 1/2019
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-019-1123-8