Nonsteroidal MRAs Reduce Renal Risks

NONSTEROIDAL mineralocorticoid receptor (MR) antagonists (MRAs) reduce the risk of renal and cardiovascular outcomes in patients with and without chronic kidney disease (CKD), findings from a new systematic review and meta-analysis suggest. Use of the drugs may also reduce albuminuria and blood pressure.

“Overactivation of [the] MR promotes inflammation, oxidative stress and fibrosis and is one of the key factors leading to the development and progression of kidney and cardiovascular damage,” Jingwei Zhou, MD, of Dongzhimen Hospital of Beijing University of Chinese Medicine in China and colleagues explained in Diabetes Research and Clinical Practice MRAs, they noted, “can directly target aldosterone to play an anti-inflammatory and antifibrotic role and can provide cardiorenal protection, including beneficial effects in hypertension, heart failure and chronic kidney disease (CKD),” they wrote.

The investigators pooled data from 11 randomized controlled trials and 1 meta-analysis including 17,517 patients. Of the cohort, 92.6% had stage 1-5 CKD, 91.0% had type 2 diabetes, and 92.1% had hypertension. Most patients (15,607) were treated with finerenone, whereas 1456 received esaxerenone, 292 apararenone, and 162 KBP-5074.

The primary endpoint was a composite renal outcome of a sustained 40% or greater or 40% or greater decrease in estimated glomerular filtration rate (eGFR) from baseline, doubling of baseline serum creatinine, end-stage kidney disease (ESKD), or renal death.

Finerenone use was significantly associated with a 17% reduced risk of the renal composite endpoint compared with control, Dr Zhou and colleagues reported. By component, nonsteroidal MRA use was significantly associated with a 23% lower