Does it increase the risk of chronic kidney disease?

and that an existing drug that targets the action of aldosterone can help prevent CKD from getting worse.

What is aldosterone?

Aldosterone is a steroid hormone secreted by the adrenal glands, located above the kidneys. Its main role is to regulate salt and water in the body, and so it plays a central role in blood pressure control. Too much can lead to high blood pressure, cardiovascular and kidney diseases.


Are there drugs to delay the progression of chronic kidney disease?

Lead author Dr Ashish Verma, assistant professor at Boston University School of Medicine, said: “Recent randomized controlled trials have shown that a drug called finerenone is effective in delaying progression of CKD and adverse cardiovascular outcomes in patients with chronic kidney disease and diabetes.. However, the role of aldosterone in this process has not been directly studied, and levels of this hormone have not been measured. ”

How does finerenone work?

Finerenone targets the nonsteroidal mineralocorticoid receptor (MR). When this receptor is activated by aldosterone, elevated hormone levels lead to high blood pressure, cardiovascular and kidney diseases.

“Since excessive levels of aldosterone are so common, but mostly undetected, we hypothesize one reason why finerenone is effective in reducing the risk of progression,” said Dr. CKD is that it is treating unrecognized high hormone levels.”

Verma and his colleagues investigated the association between blood aldosterone levels and the progression of kidney disease among 3680 participants in a chronic kidney disease cohort study, conducted at seven clinic in the US from 2003 to 2008. Participants ranged in age from 21 to. 74 years old.

They focused on the progression of chronic kidney disease, defined as a 50% decline in the kidney’s ability to filter blood through the glomerular vessels, known as estimated glomerular filtration rate (eGFR), or kidney disease. the final stage, whichever occurs first. . They followed the patients for a median (median) period of almost ten years. During this time, progression of CKD occurred in 1412 (38%) participants.

They found that higher aldosterone levels were associated with lower eGFR, lower blood potassium levels, and higher urine potassium and protein levels.

After adjusting for factors that could affect the results, such as medication, other medical conditions, age, race, height, and weight, they found that each doubling of the concentration Aldosterone in the blood was associated with an 11% increased risk of developing CKD. Patients with the highest 25% concentrations had a 45% increased risk compared with the 25% patients with the lowest aldosterone concentrations. The risk was similar regardless of whether the patient had diabetes or not.

“These findings are important because they suggest that higher aldosterone levels may play a role in the progression of CKD and cardiovascular disease in CKD patients,” said Dr. Verma. their treatment in non-diabetic patients.”

The Food and Drug Administration (FDA) in the United States has approved the use of finerenone for patients with CKD and diabetes. Currently, a randomized controlled clinical trial is investigating the efficacy and safety of finerenone in non-diabetic CKD patients. “This trial will play an important role in answering the question of whether MR antagonist therapy is helpful in delaying the progression of CKD in CKD and nondiabetic patients,” said Dr. road or not.

Professor George Bakris, University of Chicago School of Medicine, USA, who was not involved in the study but participated in randomized controlled trials of finerenone in diabetics, wrote an accompanying editorial. study, also published today. “Taken together, these studies suggest that aldosterone levels should be assessed in all patients at risk and/or with cardiovascular disease, particularly if they have central obesity and/or hypertension. resistance, he wrote:

Limitations of the study include:

  1. There were no measurements of a protein called albumin in the urine, or another protein, renin, in the blood samples; this can indicate whether or not a high level of aldosterone is dependent on renin, which is excreted by the kidneys and also plays a role in blood pressure;
  2. Aldosterone levels were measured only once at the start of the study;
  3. Data on the duration of use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), which can affect aldosterone concentrations, are not available; and
  4. The study is observational and cannot show that aldosterone causes the progression of CKD, only that it is related to it.

In 2017, CKD affected 9.1% of the population worldwide, 697.5 million cases.

Study co-authors are Anand Vaidya from Brigham and Women’s Hospital, Boston, Sonu Subudhi from Massachusetts General Hospital, Boston, and Sushrut S. Waikar from Boston University School of Medicine.

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