Endocrinology and Metabolism

Review Article

Diabetes, Obesity and Metabolism
Renal Protection of Mineralocorticoid Receptor Antagonist, Finerenone, in Diabetic Kidney Disease: Dong-Lim Kim, Seung-Eun Lee, Nan Hee Kim; Endocrinol Metab. 2023;38(1):43-55. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2022.1629

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Chronic kidney disease (CKD) is the most common cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). CKD increases the risk of cardiovascular diseases; therefore, its prevention and treatment are important. The prevention of diabetic kidney disease (DKD) can be achieved through intensive glycemic control and blood pressure management. Additionally, DKD treatment aims to reduce albuminuria and improve kidney function. In patients with T2DM, renin-angiotensin-aldosterone system inhibitors, sodium glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists can delay the progression of DKD. Hence, there is a need for novel treatments that can effectively suppress DKD progression. Finerenone is a first-in-class nonsteroidal mineralocorticoid receptor antagonist with clinically proven efficacy in improving albuminuria, estimated glomerular filtration rate, and risk of cardiovascular events in early and advanced DKD. Therefore, finerenone is a promising treatment option to delay DKD progression. This article reviews the mechanism of renal effects and major clinical outcomes of finerenone in DKD.

Citations

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Brief Report

Diabetes, Obesity and Metabolism
Cardiovascular Outcomes with Finerenone According to Glycemic Status at Baseline and Prior Treatment with Newer Antidiabetics among Patients with Type 2 Diabetes Mellitus: Dimitrios Patoulias, Christodoulos Papadopoulos, Asterios Karagiannis, Vassilios Vassilikos, Michael Doumas; Endocrinol Metab. 2022;37(1):170-174. Published online February 9, 2022; DOI: https://doi.org/10.3803/EnM.2021.1296

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Abstract PDF Supplementary Material PubReader ePub

Type 2 diabetes mellitus (T2DM) and cardiovascular disease are closely interconnected. We sought to determine the cardioprotective action of finerenone according to prior treatment with newer antidiabetics and glycemic status. We searched PubMed and Cochrane Library from inception to October 1, 2021 for randomized controlled trials (RCTs) assessing the effect of finerenone on major adverse cardiovascular outcomes in patients with T2DM. We set the primary endpoint as major adverse cardiovascular events (MACE), defined as the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. We finally included two RCTs in our quantitative synthesis. Compared to placebo, finerenone induced a 23% risk reduction for the composite cardiovascular endpoint, regardless of prior glycemia. We also showed that finerenone provided significant cardiovascular benefit for obese patients with T2DM compared to placebo, although this benefit was diminished for subjects with a body mass index lower than 30 kg/m². Finally, the combination of finerenone with sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists did not produce a significant risk reduction for MACE. We conclude that finerenone provides significant cardiovascular benefits for patients with T2DM, especially for those who are obese, while glycemic status or treatment with newer antidiabetics at baseline does not affect the observed cardioprotective action.

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Finerenone protects against progression of kidney and cardiovascular damage in a model of type 1 diabetes through modulation of proinflammatory and osteogenic factors
M. Sanz-Gómez, F.J. Manzano-Lista, E. Vega-Martín, D. González-Moreno, M. Alcalá, M. Gil-Ortega, B. Somoza, C. Pizzamiglio, L.M. Ruilope, I. Aránguez, P. Kolkhof, R. Kreutz, M.S. Fernández-Alfonso
Biomedicine & Pharmacotherapy.2023; 168: 115661. CrossRef
Research Progress in Finerenone in Cardiovascular Diseases
Sun Xue, Dong Yanghong, Gu Jiaxin, Liu Wenxiu, Liu Yue
Cardiovascular Innovations and Applications.2023;[Epub] CrossRef

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