Finerenone — Halting Relative Hyperaldosteronism in Chronic Kidney Disease

Aldosterone plays a critical role in the progression of chronic kidney disease (CKD), particularly in diabetic kidney disease, contributing to inflammation and fibrosis. While traditional mineralocorticoid receptor antagonists (MRAs) such as spironolactone and eplerenone have demonstrated benefits in reducing albuminuria and improving cardiovascular outcomes, their use is often limited by the risk of hyperkalemia and a decline in the glomerular filtration rate (GFR). Finerenone is a new, nonsteroidal MRA with a distinct chemical structure and binding profile that allows it to effectively block mineralocorticoid receptors with a reduced propensity for causing hyperkalemia or significant GFR reduction.

The FIDELIO-DKD trial, results of which were published in the same issue, investigated finerenone in patients with CKD and type 2 diabetes. The trial demonstrated that finerenone significantly reduced the risk of CKD progression and cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure, without a substantial increase in hyperkalemia or severe GFR decline. These findings suggest that finerenone offers a novel and effective therapeutic option for managing CKD and its associated cardiovascular risks, especially in the context of type 2 diabetes, by targeting the detrimental effects of relative hyperaldosteronism.

Aldosterone plays a critical role in the progression of chronic kidney disease (CKD), particularly in diabetic kidney disease, contributing to inflammation and fibrosis. While traditional mineralocorticoid receptor antagonists (MRAs) such as spironolactone and eplerenone have demonstrated benefits in reducing albuminuria and improving cardiovascular outcomes, their use is often limited by the risk of hyperkalemia and a decline in the glomerular filtration rate (GFR). Finerenone is a new, nonsteroidal MRA with a distinct chemical structure and binding profile that allows it to effectively block mineralocorticoid receptors with a reduced propensity for causing hyperkalemia or significant GFR reduction.

The FIDELIO-DKD trial, results of which were published in the same issue, investigated finerenone in patients with CKD and type 2 diabetes. The trial demonstrated that finerenone significantly reduced the risk of CKD progression and cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure, without a substantial increase in hyperkalemia or severe GFR decline. These findings suggest that finerenone offers a novel and effective therapeutic option for managing CKD and its associated cardiovascular risks, especially in the context of type 2 diabetes, by targeting the detrimental effects of relative hyperaldosteronism.