Clinical Associate Professor, University of Tasmania, Consultant Nephrol-ogist, Launceston General Hospital, Launceston, Australia.
Curr Opin Nephrol Hypertens. 2022 May 1;31(3):265-271. doi: 10.1097/MNH.0000000000000785. Epub 2022 Feb 14.
Clinical trials of the mineralocorticoid receptor antagonist (MRA) finerenone published recently suggest that they improve outcomes in patients with diabetic kidney disease (DKD). This review summarises key research from the last two years to provide clinicians with a synopsis of recent findings.
Large international trials, such as Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (5674 participants) and Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (7437 participants), suggest that in proteinuric patients with DKD and estimated glomerular filtration rate >25 ml/min/1.73 m2, already on renin-angiotensin-aldosterone system inhibitors, addition of finerenone provided modest further improvement in composite renal and cardiovascular outcomes. Proteinuria was reduced; there was also a small drop in systolic blood pressure. Hyperkalaemia remained a concern, although the incidence is lower with finerenone. Emerging data suggest that newer potassium binding agents may mitigate this risk. Preclinical studies suggest additive benefits when MRA and sodium-glucose co-transporter 2 (SGLT-2) inhibitors are used in combination.
The nonsteroidal MRA finerenone could improve renal and cardiac outcomes further in diabetics with kidney disease when added to renin-angiotensin system inhibitors. Hyperkalaemia is probably less worrisome, but real-world data is needed. Combinations with other new nephroprotective agents (such as SGLT2i inhibitors) has the potential to provide increasing benefit. Benefits of finerenone in chronic kidney disease without diabetes remains to be seen.
最近发表的关于盐皮质激素受体拮抗剂（MRA）非奈利酮的临床试验表明，它可改善糖尿病肾病（DKD）患者的结局。本文总结了过去两年的重要研究结果，为临床医生提供了最新发现的概述。
大型国际试验，如非奈利酮降低糖尿病肾病患者的肾衰竭和进展风险（5674 名参与者）和非奈利酮降低糖尿病肾病患者的心血管死亡率和发病率（7437 名参与者）表明，在蛋白尿的 DKD 患者和估算肾小球滤过率（eGFR）>25ml/min/1.73m2 ，已经接受肾素-血管紧张素-醛固酮系统抑制剂治疗的患者中，添加非奈利酮可适度进一步改善复合肾脏和心血管结局。蛋白尿减少，收缩压也略有下降。高钾血症仍然是一个问题，尽管非奈利酮的发生率较低。新出现的数据表明，新型钾结合剂可能降低这种风险。临床前研究表明，当 MRA 和钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂联合使用时，可能会带来额外的益处。
当添加到肾素-血管紧张素系统抑制剂中时，非甾体 MRA 非奈利酮可进一步改善患有肾脏疾病的糖尿病患者的肾脏和心脏结局。高钾血症可能不那么令人担忧，但需要真实世界的数据。与其他新的肾脏保护剂（如 SGLT2i 抑制剂）联合使用可能具有增加获益的潜力。非奈利酮在非糖尿病慢性肾脏病中的获益尚待观察。
