New possibilities of nephroprotection in type 2 diabetes using finerenone Consensus of the board of experts

Abstract

Patients with chronic kidney disease (CKD) belong to the category of patients with diabetes mellitus (DM), which are the most difficult to treat. They require a multidisciplinary, multifactorial approach to slow disease progression, reduce glomerular filtration rate (GFR), and prevent cardiovascular morbidity and mortality. Modern treatment of CKD in patients with type 2 diabetes involves influencing various links of its pathogenesis. The use of finerenone is a fundamentally new approach in treatment of CKD. Inflammation and fibrosis, which develop as a result of excessive activation of mineralocorticoid receptors, are key pathophysiological mechanisms of the development and progression of CKD in patients with type 2 DM. Therefore, the blocking of mineralocorticoid receptors (MCR) with the innovative nonsteroidal selective MCR antagonist finerenone is a promising way to improve the clinical course of CKD, and has a favorable prognostic effect on the rate of progression of CKD and on the risk of cardiovascular events. The feasibility of adding finerenone to the treatment regimens of patients with CKD and type 2 diabetes in order to reduce the rate of progression of CKD and reduce the frequency of cardiovascular events is substantiated by convincing data from clinical studies and reflected in the recommendations of the American Diabetes Association, 2023. The innovative drug finerenone has a direct nephroprotective effect, which reliably slows down the progression of CKD in patients with type 2 diabetes. Therefore, finerenone should be considered for prescribing from the initial stage of kidney damage. When using finerenone, the risk of developing hyperkalemia is low, which minimizes the risk of withdrawal of the drug during treatment. Despite the available modern methods of treatment, which are primarily aimed at the hemodynamic and metabolic factors of the development of CKD in type 2 diabetes mellitus, the introduction of the specified new pathogenetic approach using finerenone, as a means whose mechanism of action is due to a direct effect on inflammation and fibrosis, is considered necessary from the point of view of improving the clinical course of CKD and the prognosis.