Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy

Bakris, George L.; Agarwal, Rajiv; Chan, Juliana C.N.; Cooper, Mark E.; Gansevoort, Ron T.; Haller, Hermann; Remuzzi, Giuseppe; Rossing, Peter; Schmieder, Roland E.; Nowack, Christina; Kolkhof, Peter; Joseph, Amer; Pieper, Alexander; Kimmeskamp-Kirschbaum, Nina; Ruilope, Luís M.

doi:10.1001/jama.2015.10081

Cited by 567 publications

(416 citation statements)

References 25 publications

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“…Novel therapeutic agents, such as potassium binders, may protect against hyperkalemia in patients with heart failure who are at risk of hyperkalemia with MRA use, though additional studies are needed 30. Furthermore, development of more‐selective MRA therapies may achieve the benefits of MRA therapy with fewer adverse events 31, 32. In addition, appropriate patient selection and laboratory monitoring during therapy may decrease the risk of adverse events 33, 34, 35.…”

Section: Discussionmentioning

confidence: 99%

Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease

Cooper

Lippmann

Greiner

et al. 2017

JAHA

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BackgroundPerceived risks of hyperkalemia and acute renal insufficiency may limit use of mineralocorticoid receptor antagonist (MRA) therapy in patients with heart failure, especially those with diabetes mellitus or chronic kidney disease.Methods and ResultsUsing clinical registry data linked to Medicare claims, we analyzed patients hospitalized with heart failure between 2005 and 2013 with a history of diabetes mellitus or chronic kidney disease. We stratified patients by MRA use at discharge. We used inverse probability–weighted proportional hazards models to assess associations between MRA therapy and 30‐day, 1‐year, and 3‐year mortality, all‐cause readmission, and readmission for heart failure, hyperkalemia, and acute renal insufficiency. We performed interaction analyses for differential effects on 3‐year outcomes for reduced, borderline, and preserved ejection fraction. Of 16 848 patients, 12.3% received MRA therapy at discharge. Higher serum creatinine was associated with lower odds of MRA use (odds ratio, 0.66; 95% confidence interval, 0.61–0.71); serum potassium was not (odds ratio, 1.00; 95% confidence interval, 0.90–1.11). There was no mortality difference between groups. MRA therapy was associated with greater risks of readmission for hyperkalemia and acute renal insufficiency and lower risks of long‐term all‐cause readmission. Patients on MRA therapy with borderline or preserved ejection fraction had greater risks of readmission for hyperkalemia (P=0.02) and acute renal insufficiency (P<0.001); patients with reduced ejection fraction did not.ConclusionsAmong patients with heart failure and diabetes mellitus or chronic kidney disease, MRA use was associated with lower risk of all‐cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.

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Section: Discussionmentioning

confidence: 99%

Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease

Cooper

Lippmann

Greiner

et al. 2017

JAHA

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“…Novel agents targeting mechanisms, such as glomerular hyperfiltration, inflammation, and fibrosis, have been a major focus for development of new treatments. Agents that have shown promise include ruboxistaurin, a protein kinase C-b inhibitor (68); baricitinib, a selective Janus kinase 1 and Janus kinase 2 inhibitor (69); pentoxifylline, an anti-inflammatory and antifibrotic agent (70); atrasentan, a selective endothelin A receptor antagonist (71,72); and finerenone, a highly selective nonsteroidal mineralocorticoid receptor antagonist (Table 4) (73). However, thus far, there are no available phase 3 clinical trial data for these agents, and none are approved for use in DKD.…”

Section: Novel Therapies and Approachesmentioning

confidence: 99%

Diabetic Kidney Disease

Alicic

Rooney

Tuttle

2017

CJASN

1,839

786

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“…In patients with diagnosed diabetic nephropathy, the addition of finerenone to an AngII-receptor blocker or ACE inhibitor resulted in improvements in the urinary albumin/creatinine ratio compared with placebo 86 . Likewise, a second study in Japanese patients with diabetic nephropathy found an anti-albuminuric effect of finerenone addition to inhibition of renin-Ang system, without increases in serum potassium or deterioration of glomerular filtration 87 .…”

Section: Mcr Antagonists May Provide Renal Benefits In Patients With mentioning

confidence: 99%

Aldosterone and the mineralocorticoid receptor in insulin resistance and diabetes

Toloza

Mendivil

2020

ALAD

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Aldosterone is a key regulator of water and electrolyte metabolism, but recent evidence from multiple lines of research also identifies it as a major player in other chronic disorders, particularly diabetes and the metabolic syndrome. In this review, we summarize relevant aspects of aldosterone production, secretion, action, the way aldosterone and the mineralocorticoid receptor may impact energy metabolism, and useful take-home messages concerning mineralocorticoid antagonism in patients with type 2 diabetes mellitus. (Rev ALAD. 2017;7:203-11) RESUMENLa aldosterona es un regulador clave del metabolismo del agua y los electrólitos, pero la evidencia reciente de múltiples líneas de investigación también la identifica como un actor principal en otros trastornos crónicos, en particular en la diabetes y el síndrome metabólico. En esta revisión se resumen los aspectos relevantes de la producción de aldosterona, así como su secreción, su acción y la forma en que la aldosterona y el receptor mineralocorticoide pueden afectar al metabolismo energético, además de aportar información útil sobre el antagonismo mineralocorticoide en pacientes con diabetes mellitus de tipo 2.Palabras clave: Aldosterona. Metabolismo de los electrólitos. Diabetes. Síndrome Metabólico.

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Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy

Abstract: clinicaltrials.gov Identifier: NCT1874431.

Cited by 567 publications

References 25 publications

Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease

Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease

Diabetic Kidney Disease

Aldosterone and the mineralocorticoid receptor in insulin resistance and diabetes

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