Finerenone — Halting Relative Hyperaldosteronism in Chronic Kidney Disease

This editorial discusses the role of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in managing chronic kidney disease (CKD) and diabetic nephropathy. Unlike traditional steroidal antagonists (e.g., spironolactone, eplerenone), finerenone offers selective receptor inhibition with a reduced risk of hyperkalemia and other side effects. The phase 3 FIDELIO-DKD trial demonstrated finerenone's efficacy in slowing CKD progression and reducing cardiovascular risk in patients with type 2 diabetes, though its renoprotective effects were modest compared to SGLT2 inhibitors. The authors highlight finerenone's potential to mitigate inflammation and fibrosis via mineralocorticoid receptor blockade, while calling for longer-term studies and comparative trials with other emerging therapies. This approach represents a promising strategy to address relative hyperaldosteronism in CKD.

This editorial discusses the role of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in managing chronic kidney disease (CKD) and diabetic nephropathy. Unlike traditional steroidal antagonists (e.g., spironolactone, eplerenone), finerenone offers selective receptor inhibition with a reduced risk of hyperkalemia and other side effects. The phase 3 FIDELIO-DKD trial demonstrated finerenone's efficacy in slowing CKD progression and reducing cardiovascular risk in patients with type 2 diabetes, though its renoprotective effects were modest compared to SGLT2 inhibitors. The authors highlight finerenone's potential to mitigate inflammation and fibrosis via mineralocorticoid receptor blockade, while calling for longer-term studies and comparative trials with other emerging therapies. This approach represents a promising strategy to address relative hyperaldosteronism in CKD.