https://orcid.org/0000-0002-9805-9523
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ABSTRACT
Introduction
Patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD) are at high risk of CKD progression and cardiovascular events. Despite treatment with renin-angiotensin system inhibitors and SGLT-2 inhibitors, the residual risk is substantial. There is preclinical and clinical evidence supporting a key role of mineralocorticoid receptor in cardiorenal injury in T2DM.
Areas covered
Finerenone is a selective and nonsteroidal mineralocorticoid receptor antagonist that reduces -on preclinical studies- heart and kidney inflammation and fibrosis. Clinical trials have demonstrated that among patients with T2DM and CKD, finerenone reduces CKD progression and the risk of cardiovascular events. The incidence of adverse events is similar than for placebo. Permanent discontinuation of study drug due to hyperkalemia was low (1.7% of finerenone and 0.6% of placebo participants) as was the risk of hyperkalemia-related severe-adverse events (1.1%). We provide an overview of risk factors for hyperkalemia and management of serum potassium in people with CKD and T2DM on finerenone.
Expert opinion
As finerenone increases potassium levels in a predictable way, patients at risk of hyperkalemia can be identified early in clinical practice and monitored for an easy management. This will allow people with T2DM and CKD to safely benefit from improved cardiorenal outcomes.
Article highlights
Patients with type 2 diabetes and CKD are at high risk of CKD progression and cardiovascular events, even when treated with RAS inhibitors or SGLT-2 inhibitors.
MR plays a key role in the development of cardiorenal disease in patients with type 2 diabetes and CKD.
Finerenone is a selective and nonsteroidal MR antagonist that reduces heart and kidney inflammation and fibrosis, leading to a delay of CKD progression and a reduction of cardiovascular complications among patients with type 2 diabetes and CKD.
Although the risk of hyperkalemia is increased in patients taking finerenone, permanent discontinuation is low, as well as the risk of hyperkalemia-related severe adverse events.
In addition, as finerenone increases potassium levels in a predictable way, the early identification of patients at risk, as well as the adequate monitoring of potassium levels will reduce the risk of hyperkalemia.
Acknowledgments
Writing and editorial assistance was provided by Content Ed Net (Madrid, Spain) and funded by Bayer Hispania.
Declaration of interest
A Ortiz has received grants from Sanofi and consultancy or speaker fees or travel support from Adviccene, Alexion, Astellas, Astrazeneca, Amicus, Amgen, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Lilly, Freeline, Idorsia, Chiesi, Otsuka, Novo-Nordisk, Sysmex and Vifor Fresenius Medical Care Renal Pharma and is Director of the Catedra Mundipharma-UAM of diabetic kidney disease and the CatedraAstrazeneca-UAM of chronic kidney disease and electrolytes. He has stock in TelaraFarma.
R Alcázar Arroyo has received consultancy or speaker fees or travel support from AstraZeneca, Bayer, Novo-Nordisk, Boehringer Ingelheim, Rubió, CSL-Vifor and Fresenius Medical Care
PP Casado Escribano has received consultancy or speaker fees or travel support from Almirall, Boehringer Ingelheim, Esteve, Lilly, Novartis, Novo Nordisk and Sanofi-Aventis, and participated in clinical trials with Novo Nordisk.
B Fernandez-Fernandez has received grants from Esteve and consultancy or speaker fees or travel support from Astrazeneca, Boehringer Ingelheim, Bayer, Menarini, Mundipharma, Novo-Nordisk and has worked for CatedraMundipharma-UAM of diabetic kidney disease and is editor of Nefroplus.
F Martínez Debén has received consultancy or speaker fees or travel support from Almirall, BMS, Boehringer Ingelheim, Daichii Sankyo, Esteve, MSD, Novartis, Pfizer, Sanofi-Aventis, and participated in clinical trials with Astrazeneca, Bayer, MSD, Novartis, Pfizer, and Sanofi-Aventis.
A Michan-Doña has received consultancy or speaker fees or travel support from Almirall, BMS, Boehringer Ingelheim, Esteve, Ferrer Grupo, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi-Aventis, and Servier and participated in clinical trials with Bayer, MSD, GSK and Sanofi-Aventis.
MJ Soler has received personal fees from NovoNordisk (fees, consulting), Janssen (fees), Boehringer (fees, consulting, grants and consulting), Eli Lilly (fees), AstraZeneca (fees and consulting), Esteve (fees), Fresenius Medical Care (fees), Mundipharma (fees and advice), NovoNordisk (fees, advice and advice), Bayer (fees, advice and advice), Travere Therapeutics (fees and advice), GE Healthcare (advice) and Vifor (fees and advice).
MJ Soler has received personal fees from NovoNordisk (fees, consulting), Janssen (fees), Boehringer (fees, consulting, grants and consulting), Eli Lilly (fees), AstraZeneca (fees and consulting), Esteve (fees), Fresenius Medical Care (fees), Mundipharma (fees and advice), NovoNordisk (fees, advice and advice), Bayer (fees, advice and advice), Travere Therapeutics (fees and advice), GE Healthcare (advice) and Vifor (fees and advice).
JL Górriz has been an advisor on scientific boards for AstraZeneca, Bayer and Novo Nordisk; lectures for AstraZeneca, Boehringer Ingelheim, Esteve, Bayer, Eli Lilly and Company, Mundipharma, Novartis, Bayer, Astellas and Novo Nordisk and research activities for AstraZeneca.
The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.