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Mineralocorticoid Receptor Antagonists for Nephroprotection: Current Evidence and Future Perspectives

Author(s):

Pantelis A. Sarafidis*, Evangelos Memmos and Aikaterini Papagianni   Pages 1 - 9 ( 9 )

Abstract:


Background: The use of single RAS-blockade is currently the recommended first-line treatment for proteinuric diabetic or non-diabetic nephropathy, as these agents were repeatedly shown in studies with hard renal outcomes to retard the progression of renal injury. However, CKD will continue to progress on optimum single RAS-blockade, and other options to ameliorate renal injury were explored. Dual RAS-blockade was associated with increased risk of adverse-events with no apparent benefits and is currently abandoned.

Objectives: Based on the phenomenon of aldosterone escape and the well-documented harmful effects of aldosterone on renal tissue, several randomized trials have studied the effects of a MRA in diabetic and non-diabetic nephropathy.

Method: We conducted an in-depth search of the literature in relevance to data evaluating the effect of MRA on renal outcomes.

Results: Studies with spironolactone and eplerenone added to single RAS-blockade showed that these agents are associated with greater reductions in urine albumin or protein excretion compared to either placebo or dual RAS-blockade. Hence, there is no data on hard renal outcomes, the reasonable skepticism of physicians on the real-world incidence of hyperkalemia in CKD patients is limiting their use. A non-steroidal MRA, finerenone, has also great potency in decreasing albuminuria in diabetic nephropathy with possibly lower rates of hyperkalemia. Two multi-center clinical trials examining the effect of finerenone on hard cardiovascular and renal outcomes are currently ongoing.

Conclusion: This review summarizes data on the effects of MRAs on albuminuria and proteinuria in CKD and discusses the potential for their clinical use.

Keywords:

chronic kidney disease, mineralocorticoid receptor antagonist, albuminuria, proteinurea, spironolactone, eplerenone, finerenone

Affiliation:

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki



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