Carlino Irene, Pirrotta Filippo, Gennari Luigi, Palazzuoli Alberto
Internal Medicine Unit, Department of Medical and Surgical Sciences, University of Siena, 53100 Siena, Italy.
Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital Siena, 53100 Siena, Italy.
Biomedicines. 2025 Jul 10;13(7):1693. doi: 10.3390/biomedicines13071693.
Heart failure (HF) treatment evolved in the last 5 years with the introduction of new agents capable of reducing HF hospitalization and HF-related mortality. However, some categories such as patients with renal dysfunction tend to be excluded from larger randomized clinical trials. Additionally, most patients with HF experienced unavoidable glomerular filtration rate (GFR) deterioration during the clinical course. This is related to both cardio-renal interaction pathways and common cardiovascular risk factors that affect HF and chronic kidney disease (CKD). However, mineralocorticoid antagonists (MRAs) remain a cornerstone of HF therapy regardless of left ventricular ejection fraction (LVEF) values; some concerns remain about their utilization in CKD. Nevertheless, three studies (FIDELIO, FIGARO, and FINEARTS) have recently showed beneficial effects in both patients with HF and CKD associated with diabetes. Notably, finerenone a new non-steroidal MRA represents a significant step forward in cardiovascular therapy; its application spans a wide spectrum of HF phenotypes and CKD stages, and ongoing investigations will further elucidate its role in combination regimens and in broader patient populations. Further study may investigate the role of the drug in patients with heart failure with reduced ejection fraction (HFrEF) and in the severe CKD stage of non-diabetic etiology. In the current review paper, we provide a chronological overview of major trials evaluating the renal outcomes of MRAs, culminating in the emergence of finerenone as a novel therapeutic option for high-risk CKD populations, particularly those with type 2 diabetes mellitus (T2DM).
在过去5年中，随着能够降低心力衰竭（HF）住院率和HF相关死亡率的新型药物的引入，HF治疗取得了进展。然而，某些类别患者，如肾功能不全患者，往往被排除在大型随机临床试验之外。此外，大多数HF患者在临床过程中经历了不可避免的肾小球滤过率（GFR）恶化。这与心肾相互作用途径以及影响HF和慢性肾脏病（CKD）的常见心血管危险因素均有关。然而，无论左心室射血分数（LVEF）值如何，盐皮质激素拮抗剂（MRAs）仍然是HF治疗的基石；对于它们在CKD中的应用仍存在一些担忧。尽管如此，最近三项研究（FIDELIO、FIGARO和FINEARTS）显示，MRAs对合并糖尿病的HF和CKD患者均有有益作用。值得注意的是，非奈利酮这种新型非甾体MRA代表了心血管治疗的重大进展；其应用涵盖了广泛的HF表型和CKD阶段，正在进行的研究将进一步阐明其在联合治疗方案和更广泛患者群体中的作用。进一步的研究可能会探究该药物在射血分数降低的心力衰竭（HFrEF）患者以及非糖尿病病因的重度CKD阶段患者中的作用。在本综述文章中，我们按时间顺序概述了评估MRAs肾脏结局的主要试验，最终非奈利酮作为高危CKD人群，特别是2型糖尿病（T2DM）患者的一种新型治疗选择出现。
