Nugroho Pringgodigdo
Department of Internal Medicine, Division of Nephrology and Hypertension, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia.
Endocr Metab Immune Disord Drug Targets. 2025 Jan 8. doi: 10.2174/0118715303350851241021105850.
Chronic kidney disease (CKD) is a major complication of type 2 diabetes mellitus (T2D), which often leads to diabetic kidney disease (DKD). Traditional therapies, including renin- angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter-2 inhibitors, are effective in slowing CKD progression. However, these approaches are insufficient to comprehensively inhibit mineralocorticoid receptor (MR) overactivation in the kidneys, which remains a significant driver of inflammation, fibrosis, and oxidative stress. These pathological processes accelerate kidney damage and cardiovascular complications. Finerenone-a nonsteroidal mineralocorticoid receptor antagonist-represents a new frontier in renal protection. Unlike steroidal mineralocorticoid antagonists (MRAs), finerenone offers a more selective MR blockade, reducing kidney inflammation and fibrosis without significantly raising serum potassium levels. Landmark trials have demonstrated the ability of finerenone to significantly reduce kidney and cardiovascular events in patients with T2D and CKD. Clinical evidence has highlighted finerenone as an effective option for slowing DKD progression while maintaining a favorable safety profile. Based on these findings, recent guidelines have incorporated finerenone as a recommended therapy for patients with T2D and CKD, emphasizing its role in reducing both renal and cardiovascular risks. This review provides a comprehensive overview of the available data to offer a deeper understanding of the potential of finerenone to transform CKD management for T2D patients.
慢性肾脏病（CKD）是2型糖尿病（T2D）的主要并发症，常导致糖尿病肾病（DKD）。包括肾素 - 血管紧张素 - 醛固酮系统抑制剂和钠 - 葡萄糖协同转运蛋白2抑制剂在内的传统疗法，在减缓CKD进展方面是有效的。然而，这些方法不足以全面抑制肾脏中盐皮质激素受体（MR）的过度激活，而这仍然是炎症、纤维化和氧化应激的重要驱动因素。这些病理过程会加速肾脏损伤和心血管并发症。非奈利酮——一种非甾体类盐皮质激素受体拮抗剂——代表了肾脏保护的新前沿。与甾体类盐皮质激素拮抗剂（MRAs）不同，非奈利酮提供了更具选择性的MR阻断作用，可减少肾脏炎症和纤维化，而不会显著提高血清钾水平。具有里程碑意义的试验已证明非奈利酮能够显著降低T2D和CKD患者的肾脏和心血管事件。临床证据已突出表明非奈利酮是减缓DKD进展同时保持良好安全性的有效选择。基于这些发现，近期指南已将非奈利酮纳入T2D和CKD患者的推荐治疗方案，强调其在降低肾脏和心血管风险方面的作用。本综述全面概述了现有数据，以更深入地了解非奈利酮在改变T2D患者CKD管理方面的潜力。
