Journal of Kidney

Finerenone: A New Treatment for Chronic Kidney Disease and Type 2 Diabetes Mellitus Patients

Fred Andrews^{* *}Correspondence: Fred Andrews, Editorial Office, Journal of Kidney, Brussels, Belgium, Email:

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Commentary

T2DM affects an estimated 463 million individuals globally, or 1 in every 11 adults. Furthermore, the fast spread of this condition has resulted in a high prevalence of Diabetic Kidney Disease (DKD), which is the leading cause of chronic renal disease, along with hypertension (CKD). Hyperglycemia, low-grade inflammation, altered lipid metabolism, and hyper activation of the Renin-Angiotensin-Aldosterone System (RAAS) all appear to play a role in T2DM and microvascular consequences. Drugs like sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have increased the capacity to delay the course of DKD and have shown improvements in cardiovascular disease as well.

Chronic Kidney Disease (CKD) is one of the most pressing public health issues of the future, owing to its increased financial and human resource demands on healthcare systems, among other things. Furthermore, Type 2 Diabetes Mellitus (T2DM) is on the rise, high rate of Diabetic Kidney Disease (DKD), which, when combined. The major cause of CKD progression to end-stage is hypertension. ESKD is a kind of kidney disease that necessitates the use of renal replacement treatments. Drugs like sodium–glucose cotransporter 2 have been introduced. Inhibitors of the glucagon-like peptide 2 (SGLT-2) enzyme and agonists of the Glucagonlike Peptide 1 (GLP-1) receptor with further research, the capacity to delay the growth of DKD has increased. However, the remaining kidney risk outweighs the advantages in Cardiovascular Disease (CVD) continues to be high, and renal progression has not been halted fully.

DKD development is linked to persistent RAAS hyper activation, and the importance of MRAs in individuals affected has been quickly recognized by the medical community due to a clear physiological link, since mineralocorticoid receptors are found in a variety of tissues, kidneys and heart cells are examples of such tissues. These receptors are blocked. MRA has haemodynamic and non-haemodynamic consequences. As a result, inflammation and fibrosis are reduced, and the progression of cancer is slowed cardio renal disease's development. For decades, steroidal MRAs have been used to treat hypertension, primary aldosteronism, and heart failure, most prevalent symptoms are oxidative stress, inflammation, and renal fibrosis. CKD endpoints from a variety of causes, including DKD. Several MRA has been demonstrated to enhance kidney function in both experimental and clinical investigations. Reduced renal death or a doubling of creatinine levels are examples of positive outcomes, decreased proteinuria, and no impact on estimated GFR (equivalent glomerular filtration rate). While more evidence from ongoing and future research is expected, prior studies may give useful information. The ROTATE-3 (Rotation for Optimal Targeting of Albuminuria and Treatment Evaluation) experiment investigates the relationship between albuminuria and rotation to determine the individual's albuminuria-lowering medication groups in diabetic and non-diabetic individuals with CKD. Beyond the traditional use of RAAS inhibition with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in the treatment of DKD progression, the combination of SGLT-2 inhibitors, GLP-1 receptor blockers, and ACE inhibitors has shown promise in the treatment of DKD progression. Agonists and nonsteroidal MRAs are predicted to be utilized more often in the future. Current data in the cardiovascular sector supports the use of a combination of slowing the course of diabetes with SGLT-2 inhibitors and GLP-1 receptor agonists DKD, which is good for the kidneys and the heart. These medications have been shown to be effective and have a synergistic effect on weight loss and blood pressure reduction.

Novel MRAs have shown to be effective in reducing the course of CKD in diabetic individuals. Finerenone has a distinct side effect and has a lesser effect on serum potassium levels than traditional MRAs. SGLT-2 inhibitors and GLP-1 receptor agonists, for example, have a similar profile. agonists, for the treatment of CKD in people with type 2 diabetes. As a result, merging RAAS is a good idea. Novel hypoglycemic medications such as SGLT-2 inhibitors, blocking Finerenone with a GLP-1 receptor agonist will allow DKD to be treated by addressing various important aspects of the disease's course, such as haemodynamics with adequate and safe glycaemic control, dysfunction, inflammation, and fibrosis control. Finally, fresh evidence for finerenone in the cardio renal system is emerging. Although the field is still in the works, it is one of the most promising therapies for patients.