부산대학교 도서관

Mineralocorticoid receptor (MR) overactivation in chronic kidney disease (CKD) patients causes sodium and fluid retention and provokes inflammation and fibrosis in kidney, blood vessels and heart. These processes may play an important role in progression of cardiorenal disease. Therefore, blockage of MR is an attractive therapeutic strategy. Several pre-clinical studies showed that mineralocorticoid receptor antagonists (MRAs) can treat CKD and retard its deterioration. Steroid MRAs (spironolactone and eplerenone) already showed benefits in patients with heart failure and refractory hypertension. However, the use of steroid MRAs in the treatment of CKD is currently inconclusive. Finerenone is a new, non-steroid MRA, with different molecular and pharmacokinetics from steroid MRAs. In animal study, finerenone has a more favorable benefit/risk ratio as compared with the steroid MRAs. In recent large randomized controlled trials, finerenone improved the renal and cardiovascular outcomes in type 2 diabetes and CKD patients. In this review, we describe the pathophysiology of MR and explore the efficacy and safety of steroid MRAs in CKD and end-stage renal disease (ESRD) patients. We then discuss the characteristics of finerenone and current clinical evidence in renal and cardiovascular protection.