Murugan Vignesh, Nazmin Farhana, Garcia Jian, Singareddy Sanjana, Dhakal Surakchhya, Limbaña Therese Anne, Khan Safeera
Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2024 Aug 31;16(8):e68274. doi: 10.7759/cureus.68274. eCollection 2024 Aug.
Chronic kidney disease (CKD) impacts about 10% of adults globally and substantially elevates the risk of major adverse cardiovascular events (MACE), such as heart attacks, strokes, cardiovascular-related deaths, and hospital admissions due to heart failure. The interplay between CKD and cardiovascular disease (CVD) leads to poor health outcomes. Nevertheless, there is a scarcity of systematic reviews focusing on the effectiveness of finerenone, a new non-steroidal mineralocorticoid receptor antagonist (MRA), in lowering these risks. In this systematic review, we aim to evaluate the impact of finerenone on reducing MACE in individuals with CKD and type 2 diabetes mellitus (T2DM). CKD pathophysiology involves hyperglycemia, hypertension, and dyslipidemia, leading to glomerular hyperfiltration, inflammation, and fibrosis. Traditional treatments, including angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i), often fall short in preventing cardiovascular events. Steroidal MRAs like spironolactone and eplerenone, while effective in reducing proteinuria, are limited by hyperkalemia risks. Finerenone offers a more selective mechanism, reducing sodium retention, inflammation, and fibrosis, with a lower risk of hyperkalemia. We searched five electronic databases comprehensively, identifying studies consistently demonstrating that finerenone significantly reduces MACE and improves renal outcomes by reducing albuminuria and slowing the fall in estimated glomerular filtration rate (eGFR). However, limitations include study heterogeneity, short follow-up periods, and potential publication bias. In conclusion, finerenone shows promise as a therapeutic option for CKD and T2DM, reducing MACE and improving renal outcomes. Further research is needed to understand its long-term benefits and safety across diverse populations.
慢性肾脏病（CKD）影响着全球约10%的成年人，并大幅提高了主要不良心血管事件（MACE）的风险，如心脏病发作、中风、心血管相关死亡以及因心力衰竭住院。CKD与心血管疾病（CVD）之间的相互作用导致健康状况不佳。然而，针对新型非甾体类盐皮质激素受体拮抗剂（MRA）非奈利酮降低这些风险有效性的系统评价却很匮乏。在本系统评价中，我们旨在评估非奈利酮对降低CKD合并2型糖尿病（T2DM）患者发生MACE的影响。CKD的病理生理学涉及高血糖、高血压和血脂异常，导致肾小球高滤过、炎症和纤维化。包括血管紧张素转换酶抑制剂（ACEi）、血管紧张素II受体阻滞剂（ARBs）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在内的传统治疗方法，在预防心血管事件方面往往效果不佳。像螺内酯和依普利酮这样的甾体类MRA，虽然在降低蛋白尿方面有效，但受高钾血症风险的限制。非奈利酮提供了一种更具选择性的作用机制，可减少钠潴留、炎症和纤维化，高钾血症风险较低。我们全面检索了五个电子数据库，发现多项研究一致表明，非奈利酮可显著降低MACE，并通过减少蛋白尿和减缓估计肾小球滤过率（eGFR）下降来改善肾脏结局。然而，局限性包括研究的异质性、随访期短以及潜在的发表偏倚。总之，非奈利酮作为CKD和T2DM的一种治疗选择显示出前景，可降低MACE并改善肾脏结局。需要进一步研究以了解其在不同人群中的长期益处和安全性。
