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New Therapies for the Management of Chronic Kidney Disease

Andrew M Treihaft1, Manish A Parikh1,2, Kaedrea A Jackson3,4

  • 1Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA.

Cureus
|May 8, 2025
PubMed

Insights

Chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients increases cardiovascular risks. Aldosterone synthase inhibitors (ASIs) show promise as a potential fifth pillar for managing CKD progression.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Chronic kidney disease (CKD) significantly elevates cardiovascular morbidity and mortality in type 2 diabetes mellitus (T2DM) patients.
  • Current CKD management involves lifestyle changes and four pharmacological pillars: RASi, SGLT2i, GLP-1RA, and MRAs.
  • Incomplete aldosterone blockade contributes to kidney damage progression.

Purpose of the Study:

  • To explore the potential of aldosterone synthase inhibitors (ASIs) as a novel therapeutic strategy for CKD.
  • To evaluate the role of ASIs in managing aldosterone activity and its impact on kidney disease progression.

Main Methods:

  • Review of current pharmacological approaches in CKD management.
  • Analysis of early-phase trial data for ASIs, such as vicadrostat.
  • Assessment of ASIs' effects on albuminuria and potential renal protection.

Main Results:

  • Early trials indicate ASIs can reduce albuminuria.
  • ASIs demonstrate potential for renal protection by selectively inhibiting aldosterone synthesis.
  • Preservation of cortisol production is a key feature of ASI action.

Conclusions:

  • Aldosterone synthase inhibitors (ASIs) may represent a new therapeutic pillar in CKD management.
  • ASIs offer a targeted approach to address incomplete aldosterone blockade, a factor in CKD progression.
  • Further research is warranted to establish ASIs as a fifth pillar for curbing CKD progression in T2DM patients.

Keywords:
ace inhibitorsaldosteronechronic kidney diseasemineralocorticoid receptor antagonistssglt2 inhibitors

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