Aldosterone, Mineralocorticoid Receptor Activation, and CKD: A Review of Evolving Treatment Paradigms

Area of Science:

• Nephrology
• Endocrinology
• Pharmacology

Background:

• Mineralocorticoid receptor (MR) activation drives kidney injury, inflammation, fibrosis, and chronic kidney disease (CKD) progression.
• MR antagonism has demonstrated efficacy in clinical studies for attenuating progressive kidney disease.
• The nonsteroidal MR antagonist (MRA) finerenone is FDA-approved for CKD treatment.

Purpose of the Study:

• To review the basic science and clinical applications of MR antagonism in kidney disease.
• To discuss finerenone-associated hyperkalemia and mitigation strategies.
• To explore the potential of MR antagonism in non-diabetic kidney disorders.

Main Methods:

• Review of existing clinical studies and scientific literature on MR antagonism.
• Analysis of data regarding finerenone efficacy and safety, particularly hyperkalemia.
• Discussion of ongoing and future clinical trials for broader MRA application.

Main Results:

• MR antagonism is a validated therapeutic strategy for CKD.
• Hyperkalemia is a key challenge in MR blockade, requiring management strategies.
• MR activation contributes to kidney pathology in both diabetic and non-diabetic CKD.

Conclusions:

• MR antagonism holds significant promise for managing progressive kidney disease.
• Effective management of hyperkalemia is crucial for optimizing MRA therapy.
• Expanding MR antagonism to non-diabetic kidney diseases is a key area for future research and clinical trials.