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Mitigating risk of aldosterone in diabetic kidney disease

Marie Frimodt-Møller1, Frederik Persson, Peter Rossing

  • 1Steno Diabetes Center Copenhagen, Gentofte Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Current Opinion in Nephrology and Hypertension
|October 11, 2019
PubMed
Abstract

Insights

Diabetic kidney disease involves aldosterone, a risk factor for heart and kidney failure. New treatments like nonsteroidal MRAs show promise in lowering aldosterone effects without severe side effects.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Diabetic kidney disease (DKD) is a major cause of end-stage kidney disease, atherosclerotic cardiovascular disease, and heart failure.
  • Aldosterone plays a critical role in promoting inflammation and fibrosis, contributing to cardio-renal failure.
  • Current therapeutic strategies for mitigating aldosterone's risks are limited.

Purpose of the Study:

  • To review the role of aldosterone in diabetic kidney disease and associated cardiovascular complications.
  • To discuss current challenges in managing aldosterone-driven risks.
  • To explore emerging therapeutic options for aldosterone antagonism.

Main Methods:

  • Review of current literature on aldosterone's role in DKD.
  • Analysis of existing and novel pharmacological approaches to aldosterone blockade.
  • Evaluation of clinical trial data for new anti-aldosterone agents.

Main Results:

  • Aldosterone is a key driver of renal and cardiovascular inflammation and fibrosis.
  • Mineralocorticoid receptor antagonists (MRAs) can reduce albuminuria and heart failure markers.
  • Novel strategies including potassium binders, aldosterone synthase inhibitors, and nonsteroidal MRAs are under investigation.
  • New MRAs show potential for lowering proteinuria and heart failure markers with limited hyperkalemia risk.

Conclusions:

  • Aldosterone significantly contributes to the progression of kidney and heart disease in diabetic patients.
  • While MRAs lower albuminuria, data on preventing end-stage kidney disease are limited.
  • Emerging treatments like nonsteroidal MRAs offer new hope for managing aldosterone-related complications in DKD with improved safety profiles.

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