People with diabetes are at a high risk of developing kidney disease in the future. Therefore, it is crucial to monitor kidney function regularly. One effective way to do this is by checking urinary protein levels. Among these, urinary albumin (also called albuminuria) is particularly important. Individuals with diabetes should undergo a urine test annually to check for urinary albumin.
Reducing urinary protein (proteinuria) can help slow the progression of kidney damage. One of the medications proven to achieve this is finerenone, which I will introduce in detail.
Finerenone is a non-steroidal selective mineralocorticoid receptor antagonist (MRA). It works by preventing the overactivation of mineralocorticoid receptors in the heart and kidneys, which directly reduces inflammation and fibrosis in the kidneys.
In the diagram below, the left section shows how aldosterone binds to mineralocorticoid receptors (MR), causing inflammation and fibrosis in the kidney. Finerenone instead binds to these receptors, effectively blocking the harmful pathway.
Recent Phase III studies focused on the effects of finerenone in patients with type 2 diabetic kidney disease. A retrospective analysis of a double-blind study confirmed:
The graph below demonstrates the superior efficacy of finerenone in reducing proteinuria compared to a placebo:
When urinary albumin decreased by more than 30%, there was a clear reduction in kidney function decline and cardiovascular events.
The table below evaluates finerenone’s effects using the proportion mediated method. This method calculates the proportion of the treatment effect achieved relative to its expected effect.
Finerenone is a promising treatment for diabetic kidney disease, showing clear benefits in reducing urinary albumin, slowing kidney disease progression, and lowering cardiovascular risks. Regular urine testing and effective treatments like finerenone can play a crucial role in managing diabetes and protecting kidney health.
Reference: Ann Intern Med. doi:10.7326/M23-1023
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