Kidney Week Educational Symposia-Mineralocorticoid Receptors: From Bedside to Bench and Back

Video Transcription

Video Summary

The session introduces two talks on mineralocorticoid receptor (MR) biology and therapy. Dr. Maria (Pitt/VA) reviews finerenone, a third‑generation nonsteroidal MR antagonist with high MR affinity and fewer androgen-related side effects than spironolactone. In the dose-ranging ARTS-DN study, finerenone reduced albuminuria (UACR) in a dose-dependent manner with modest average potassium increases and low rates of severe hyperkalemia. She then summarizes the FIDELIO-DKD and FIGARO-DKD trials in type 2 diabetes with CKD on maximally tolerated ACEi/ARB and baseline K ≤4.8. FIDELIO (more advanced CKD) showed reduced kidney-disease progression and fewer cardiovascular events; FIGARO (less advanced CKD) showed reduced cardiovascular events, largely driven by fewer heart-failure hospitalizations, with less definitive renal benefit. Across both, hyperkalemia risk was about doubled but acute kidney injury was not increased. Key open questions include real-world hyperkalemia risk and how finerenone should be combined with SGLT2 inhibitors (few participants used them in trials).<br /><br />Dr. Matt Luther (Vanderbilt) explains MR roles beyond renal sodium retention, including vascular, cardiac, and inflammatory/fibrotic effects. He reviews evidence that MR antagonism is highly effective for resistant/low-renin hypertension (e.g., PATHWAY-2). He also highlights metabolic effects of aldosterone/MR signaling—associations with metabolic syndrome, impaired insulin sensitivity, and reduced insulin secretion—supported by mouse islet studies and human primary aldosteronism data showing improved insulin secretion after treatment.

Asset Subtitle

Moderators: Michelle Gumz

Speakers:

Introduction - Michelle Gumz
Lessons Learned from FIDELIO-DKD: What Is Next? - Linda Fried
MR Function: Hemodynamic or Metabolic or Both? - James Luther

Meta Tag

Date 11/5/2021

Pathway 1 Diabetes and Metabolism

Session ID 408681

Session Type ES - Educational Symposium

Keywords

finerenone

mineralocorticoid receptor antagonist

type 2 diabetes chronic kidney disease

albuminuria UACR reduction

FIDELIO-DKD trial

FIGARO-DKD trial

hyperkalemia risk

resistant hypertension PATHWAY-2