Budućnost antagonista mineralokortikoidnih receptora u liječenju dijabetičke nefropatije. (Croatian)

Future of Mineralocorticoid Receptor Antagonists in the Treatment of Diabetic Nephropathy. (English)

Mineralocorticoid receptor antagonists (MRA) play a significant role in the treatment of resistant arterial hypertension and heart failure. There is no clinical study proving that they are the first drug of choice in the treatment of these patients. The most common limitation of the use of this group of drugs, whose most common representative is spironolactone, is hyperkalemia and sexual dysfunction, as well as gynecomastia, which is significantly less pronounced when using eplerenone, a more selective drug. Despite proven efficacy, the use of MRAs like eplerenone in patients with CKD is still limited and it is insufficiently applied in everyday practice. Finerenone, a nonsteroidal, novel, and selective antagonists of mineralocorticoid receptors shows promising differences from steroidal MRA, with a mechanism of action distinct from other agents for cardiorenal medicine in chronic kidney disease and diabetes mellitus type 2, which results in less hyperkalemia. In the FIDELIO-DKD randomized study, finerenone significantly reduced the both composite endpoints vs. placebo, suggesting that is possible postpone progression to kidney damage, thus ushering a new era in the treatment of diabetic kidney disease, which represents the most common cause of end-stage kidney disease in the world. [ABSTRACT FROM AUTHOR]

Antagonisti mineralokortikoidnih receptora imaju važnu ulogu u liječenju rezistentne arterijske hipertenzije i srčanog popuštanja. Ne postoji kliničko istraživanje koje dokazuje da su lijek prvog izbora u liječenju ovakvih bolesnika. Najčešće ograničenje primjene lijekova iz ove skupine, čiji je najčešći predstavnik spironolakton, jesu hiperkalemija i spolna disfunkcija te ginekomastija, što je mnogo manje izraženo prilikom primjene selektivnijeg eplerenona u usporedbi sa spironolaktonom. Unatoč dokazanoj učinkovitosti i smanjenoj pojavnosti hiperkalemije u odnosu prema spironolaktonu još uvijek se eplerenon nedovoljno primjenjuje u svakodnevnoj praksi, posebno u bolesnika s dijabetičkom kroničnom bubrežnom bolesti, najčešće zbog straha od hiperkalemije. Novi nesteroidni selektivniji antagonist mineralokortikoidnih receptora finerenon pokazao je obećavajuće pozitivne ishode u kardiorenalnoj medicini, primarno prevenciju napredovanja kronične bubrežne bolesti u sklopu dijabetičke nefropatije uz mnogo manju pojavnost hiperkalemije. U randomiziranom istraživanju FIDELIO-DKD finerenon je znatno smanjio primarni i sekundarni ishod u usporebi s placebom, dovodeći do usporivanja progresije bubrežnog oštećenja u bolesnika s dijabetičkom kroničnom bubrežnom bolešću, čime je otvorena nova era liječenja dijabetičke bubrežne bolesti koja je danas najčešći uzrok završnoga stupnja bubrežne bolesti u svijetu. [ABSTRACT FROM AUTHOR]

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