Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975–82. https://doi.org/10.1016/S0140-6736(14)61601-9.

Article  Google Scholar 

• Harding JL, Morton JI, Shaw JE, Patzer RE, McDonald SP, Magliano DJ. Changes in excess mortality among adults with diabetes-related end-stage kidney disease: a comparison between the United States and Australia. Nephrol Dial Transplant. 2021. https://doi.org/10.1093/ndt/gfab315. Presents the most recent data that compares mortality rates between United States and Austalia.

Afkarian M, Sachs MC, Kestenbaum B, Hirsch IB, Tuttle KR, Himmelfarb J, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302–8. https://doi.org/10.1681/ASN.2012070718.

CAS  Article  Google Scholar 

Shunan F, Jiqing Y, Xue D. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events in patients with diabetes and overt nephropathy: a meta-analysis of randomised controlled trials. J Renin Angiotensin Aldosterone Syst. 2018;19(4):1470320318803495. https://doi.org/10.1177/1470320318803495.

CAS  Article  Google Scholar 

McGuire DK, Shih WJ, Cosentino F, Charbonnel B, Cherney DZI, Dagogo-Jack S, et al. Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: A Meta-analysis. JAMA Cardiol. 2021;6(2):148–58. https://doi.org/10.1001/jamacardio.2020.4511.

Article  Google Scholar 

• Al Dhaybi O, Bakris GL. Non-steroidal mineralocorticoid antagonists: prospects for renoprotection in diabetic kidney disease. Diabetes Obes Metab. 2020;22(Suppl 1):69–76. https://doi.org/10.1111/dom.13983. Explores mechanisms and presents clinical data on how NS-MRA can slow CKD progression.

CAS  Article  Google Scholar 

Alicic RZ, Cox EJ, Neumiller JJ, Tuttle KR. Incretin drugs in diabetic kidney disease: biological mechanisms and clinical evidence. Nat Rev Nephrol. 2021;17(4):227–44. https://doi.org/10.1038/s41581-020-00367-2.

CAS  Article  Google Scholar 

Mehdi UF, Adams-Huet B, Raskin P, Vega GL, Toto RD. Addition of angiotensin receptor blockade or mineralocorticoid antagonism to maximal angiotensin-converting enzyme inhibition in diabetic nephropathy. J Am Soc Nephrol. 2009;20(12):2641–50. https://doi.org/10.1681/ASN.2009070737.

CAS  Article  Google Scholar 

Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709–17. https://doi.org/10.1056/NEJM199909023411001.

CAS  Article  Google Scholar 

• Agarwal R, Kolkhof P, Bakris G, Bauersachs J, Haller H, Wada T, et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J. 2021;42(2):152–61. https://doi.org/10.1093/eurheartj/ehaa736. Major paper exploring the mechanisms of MRA induced inflammation.

CAS  Article  Google Scholar 

• Barrera-Chimal J, Lima-Posada I, Bakris GL, Jaisser F. Mineralocorticoid receptor antagonists in diabetic kidney disease — mechanistic and therapeutic effects. Nat Rev Nephrol. 2021. https://doi.org/10.1038/s41581-021-00490-8. This a complement to reference 10 and provides a more expansive and detailed description of the mechanisms associated with inflammation and how NS MRA reduce the injury.

•• Ferreira NS, Tostes RC, Paradis P, Schiffrin EL. Aldosterone, inflammation, immune system, and hypertension. Am J Hypertens. 2021;34(1):15–27. https://doi.org/10.1093/ajh/hpaa137. Excellent review of aldosterone and inflammation.

CAS  Article  Google Scholar 

Braden GL, Chapman A, Ellison DH, Gadegbeku CA, Gurley SB, Igarashi P, et al. Advancing nephrology: Division Leaders Advise ASN. Clin J Am Soc Nephrol. 2021;16(2):319–27. https://doi.org/10.2215/CJN.01550220.

Article  Google Scholar 

Bomback AS, Klemmer PJ. The incidence and implications of aldosterone breakthrough. Nat Clin Pract Nephrol. 2007;3(9):486–92. https://doi.org/10.1038/ncpneph0575.

CAS  Article  Google Scholar 

Sato A, Hayashi K, Naruse M, Saruta T. Effectiveness of aldosterone blockade in patients with diabetic nephropathy. Hypertension. 2003;41(1):64–8. https://doi.org/10.1161/01.hyp.0000044937.95080.e9.

CAS  Article  Google Scholar 

Ai Dhaybi O, Bakris GL. Renal targeted therapies of antihypertensive and cardiovascular drugs for patients with stages 3 through 5d kidney disease. Clin Pharmacol Ther. 2017;102(3):450–8. https://doi.org/10.1002/cpt.758.

CAS  Article  Google Scholar 

•• Kintscher U, Bakris GL, Kolkhof P. Novel non-steroidal mineralocorticoid receptor antagonists in cardiorenal disease. Br J Pharmacol. 2021. https://doi.org/10.1111/bph.15747. Detailed analysis and description of the differences in pharmacology between MRAs and NS-MRAs.

Svensson M, Gustafsson F, Galatius S, Hildebrandt PR, Atar D. How prevalent is hyperkalemia and renal dysfunction during treatment with spironolactone in patients with congestive heart failure? J Card Fail. 2004;10(4):297–303. https://doi.org/10.1016/j.cardfail.2003.10.012.

CAS  Article  Google Scholar 

Dinsdale C, Wani M, Steward J, O’Mahony MS. Tolerability of spironolactone as adjunctive treatment for heart failure in patients over 75 years of age. Age Ageing. 2005;34(4):395–8. https://doi.org/10.1093/ageing/afi104.

Article  Google Scholar 

Fagart J, Hillisch A, Huyet J, Barfacker L, Fay M, Pleiss U, et al. A new mode of mineralocorticoid receptor antagonism by a potent and selective nonsteroidal molecule. J Biol Chem. 2010;285(39):29932–40. https://doi.org/10.1074/jbc.M110.131342.

Article  Google Scholar 

Barfacker L, Kuhl A, Hillisch A, Grosser R, Figueroa-Perez S, Heckroth H, et al. Discovery of BAY 94–8862: a nonsteroidal antagonist of the mineralocorticoid receptor for the treatment of cardiorenal diseases. ChemMedChem. 2012;7(8):1385–403. https://doi.org/10.1002/cmdc.201200081.

CAS  Article  Google Scholar 

Kolkhof P, Delbeck M, Kretschmer A, Steinke W, Hartmann E, Barfacker L, et al. Finerenone, a novel selective nonsteroidal mineralocorticoid receptor antagonist protects from rat cardiorenal injury. J Cardiovasc Pharmacol. 2014;64(1):69–78. https://doi.org/10.1097/FJC.0000000000000091.

CAS  Article  Google Scholar 

Pitt B, Kober L, Ponikowski P, Gheorghiade M, Filippatos G, Krum H, et al. Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94–8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J. 2013;34(31):2453–63. https://doi.org/10.1093/eurheartj/eht187.

CAS  Article  Google Scholar 

Filippatos G, Anker SD, Bohm M, Gheorghiade M, Kober L, Krum H, et al. A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J. 2016;37(27):2105–14. https://doi.org/10.1093/eurheartj/ehw132.

CAS  Article  Google Scholar 

Bakris GL, Agarwal R, Chan JC, Cooper ME, Gansevoort RT, Haller H, et al. Effect of finerenone on albuminuria in patients with diabetic nephropathy: a randomized clinical trial. JAMA. 2015;314(9):884–94. https://doi.org/10.1001/jama.2015.10081.

CAS  Article  Google Scholar 

•• Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383(23):2219–29. https://doi.org/10.1056/NEJMoa2025845. The results of the FIDELIO trial.

CAS  Article  Google Scholar 

•• Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, et al. Cardiovascular events with finerenone in kidney disease and type 2 diabetes. N Engl J Med. 2021. https://doi.org/10.1056/NEJMoa2110956. The results of the FIGARO trial.

Article  Google Scholar 

•• Agarwal R FG, Pitt B, Anker SD, Rossing P, Joseph A, Kolkhof P, Nowack C, Gebel M, Ruilope LM, and Bakris GL; on behalf of the FIDELIO-DKD and FIGARO-DKD investigators. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2021;In Press. The results of the individual patient level pooled analysis of FIGARO and FIDELIO.

Agarwal R, Fillipatos G, Pitt B. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2021;00:1–12.

Google Scholar 

• Kolkhof P, Hartmann E, Freyberger A, Pavkovic M, Mathar I, Sandner P, et al. Effects of Finerenone combined with empagliflozin in a model of hypertension-induced end-organ damage. Am J Nephrol. 2021;52(8):642–52. https://doi.org/10.1159/000516213. Animal study demonstrating the benefits of combining and SGLT2 inibititor and finerenone.

CAS  Article  Google Scholar 

Rossing P FG, Agarwal R, Anker SD, Pitt B, Ruilope LM, Chan JCN, Kooy A, McCafferty K, Schernthaner G, Wanner C, Joseph A, Scheerer MF, Scott C and Bakris GL; on behalf of the FIDELIO-DKD Investigators. Finerenone in Predominantly Advanced CKD and Type 2 Diabetes With or Without Sodium-Glucose Cotransporter-2 Inhibitor Therapy. Kidney Int Rep. 2021;In Press. https://doi.org/10.1016/j.ekir.2021.10.008.

• Agarwal R, Joseph A, Anker S, Filippatos G, Rossing P, Ruilope L, et al. Hyperkalemia risk with finerenone: results from the FIDELIO-DKD Trial. J Am Soc Nephrol. 2021. https://doi.org/10.1681/ASN.2021070942. Detailed analysis of the effects of SGLT2 inhibitor on hyperkalemia risk of finerenone.

Article  Google Scholar 

Neuen BL, Oshima M, Perkovic V, Agarwal R, Arnott C, Bakris G, et al. Effects of canagliflozin on serum potassium in people with diabetes and chronic kidney disease: the CREDENCE trial. Eur Heart J. 2021. https://doi.org/10.1093/eurheartj/ehab497.

Article  Google Scholar 

Mann JFE, Muskiet MHA. Incretin-based drugs and the kidney in type 2 diabetes: choosing between DPP-4 inhibitors and GLP-1 receptor agonists. Kidney Int. 2021;99(2):314–8. https://doi.org/10.1016/j.kint.2020.08.036.

CAS  Article  Google Scholar 

Rossing P, Agarwal R, Anker SD, Filippatos G, Pitt B, Ruilope LM, et al. Efficacy and safety of finerenone in patients with chronic kidney disease and type 2 diabetes by GLP-1RA treatment: a subgroup analysis from the FIDELIO-DKD trial. Diabetes Obes Metab. 2022;24(1):125–34. https://doi.org/10.1111/dom.14558.

CAS  Article  Google Scholar 

Sattar N, Lee MMY, Kristensen SL, Branch KRH, Del Prato S, Khurmi NS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol. 2021;9(10):653–62. https://doi.org/10.1016/S2213-8587(21)00203-5.

CAS  Article  Google Scholar 

Wei XB, Wei W, Ding LL, Liu SY. Comparison of the effects of 10 GLP-1 RA and SGLT2 inhibitor interventions on cardiovascular, mortality, and kidney outcomes in type 2 diabetes: a network meta-analysis of large randomized trials. Prim Care Diabetes. 2021;15(2):208–11. https://doi.org/10.1016/j.pcd.2020.08.017.

Article  Google Scholar