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The Role and Utility of Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease

 

Chronic Kidney Disease and Risk Management: Standards of Medical Care in Diabetes—2022
The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. In the section of that document linked here, you’ll find the 2022 recommendations for screening and treating DKD, along with background on the epidemiology of diabetes and kidney disease, surveillance, interventions, and more.

NEJM: Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes (FIDELIO-DKD)
This report published in the New England Journal of Medicine details the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) study, a phase 3, randomized, double-blind, placebo-controlled, multicenter clinical trial designed to test the hypothesis that finerenone slows CKD progression and reduces cardiovascular morbidity and mortality among patients with advanced CKD and type 2 diabetes.

Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease - FIGARO-DKD
The goal of the trial was to assess the safety and efficacy of finerenone in reducing cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). This report (updated in December 2021) published by the American College of Cardiology showed that finerenone has salutary effects on CV outcomes among patients with T2DM and CKD, who were on a background of maximal RAS blockade therapy, primarily due to a reduction in hospitalization for HF.

June 2022 updates to ADA Standard of Care Guidelines
In their updated 2022 guidelines, the American Diabetes Association (ADA) added a section directed at the prevention and management of chronic kidney disease (CKD) for patients with diabetes. Updates include changes to section 10, which addresses cardiovascular disease and risk management, and section 11, which addresses chronic kidney disease and risk management. New information was also included on calculating estimated glomerular filtration rates and the inclusion of race in the diagnosis of kidney disease.

Drug Study Offers New Hope to Patients with Both Chronic Kidney Disease and Type 2 Diabetes
“Diabetes is the leading cause of kidney failure in the U.S. People with type 2 diabetes and CKD are also three times more likely to die of cardiovascular-related causes than those with type 2 diabetes alone,” said National Kidney Foundation’s Chief Scientific Officer Kerry Willis, PhD. “Having a new therapy that tackles both of these problems is a major advance and could potentially help millions of patients to lead longer, healthier lives.”

Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease
A series of preclinical studies revealed that MR is overactivated under diabetic conditions, resulting in promoting inflammatory and fibrotic process in the kidney. Recently, nonsteroidal MRAs, including finerenone, have been developed. These agents are highly selective and have potent anti-inflammatory and anti-fibrotic properties with a low risk of hyperkalemia. This 2021 study reviews the current knowledge and future perspectives of MRAs in DKD treatment.


Archived Webinar presentation of “The Role and Utility of Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease” by Dr. Stephen A. Brunton, MD, FAAFP, CDCES, Executive Director of Primary Care Metabolic Group

 

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Citations from “The Role and Utility of Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease.”

  • Diagnosis and Management of Type 2 Diabetic Kidney Disease
    This review provides an update on the diagnosis and management of DKD based on a comprehensive review of the medical literature. Topics addressed include the evolving presentation of DKD, clinical differentiation of DKD from non-DKD, a state-of-the-art evaluation of current treatment strategies, and promising emerging treatments. It is expected that the review will help clinicians to diagnose and manage patients with DKD.

  • Transplantation in the obese: separating myth from reality
    In this review, the authors evaluate data about the safety of weight loss on dialysis and critically review the impact of pre-transplant body mass index and sarcopenia on post-transplant outcomes. They also highlight comparative data on outcomes of obese patients on dialysis versus those undergoing kidney transplantation.

  • Cardiovascular Complications of Diabetic Kidney Disease
    Diabetic nephropathy is the most common cause of chronic kidney disease and represents a large and ominous public health problem. Patients with diabetic kidney disease have exceptionally high rates of cardiovascular morbidity and mortality. In fact, the excess mortality among patients with diabetes appears to be largely limited to the subgroup with kidney disease and explained by their high burden of cardiovascular disease.
  • Diabetic kidney disease: a report from an ADA Consensus Conference
    The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world.

    Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions.

  • KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases
    This set of resources from the Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group will assist clinicians caring for individuals with glomerular disease, both adults and children. The scope includes various glomerular diseases, including IgA nephropathy (IgAN) and IgA vasculitis (IgAV), membranous nephropathy, nephrotic syndrome in children, minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), infection-related glomerulonephritis (GN), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, lupus nephritis, and anti-glomerular basement membrane (anti-GBM) antibody GN. In addition, this guideline will be the first to address the subtype of complement-mediated diseases.