The novel mineralocorticoid receptor antagonist finerenone in diabetic kidney disease: Progress and challenges

Patients with diabetic kidney disease (DKD) who received angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may show high serum levels of aldosterone. Finerenone (BAY 94-8862), a novel non-steroidal mineralocorticoid receptor antagonist (MRA), which is more selective for the mineralocorticoid receptor (MR) than spironolactone and has greater affinity for the MR than eplerenone, can reduce the concentration of aldosterone. The interaction between aldosterone and endothelin, together with their regulation on inflammation, oxidative stress and fibrosis, indicates that finerenone combined with atrasentan may play synergetic roles in reversing the procession of DKD. The present review, for the first time, discussed the mechanisms of finerenone combination with ACEI, ARBs, statins, and the endothelin receptor antagonist atrasentan.