Focus on Finerenone, a Non-Steroidal MRA in Diabetic Kidney Disease. What Physicians Should Know?

Diabetes mellitus is not only a global concern in recent times but also has become the most common cause of chronic kidney disease which has a great impact on life expectancy, development of cardiovascular diseases, allcause mortality, and morbidity. Despite the recent addition of SGLT2inhibitors along with ACEi and ARBs in the treatment armamentarium of diabetic kidney disease (DKD), there is still an unmet need to minimize the risk of progression to ESKD. Mineralocorticoid Receptor (MR) overactivation has proven to be a significant risk factor in CKD progression which has been targeted as a novel therapeutic modality. Finerenone as a non-steroidal MR Antagonist (MRA) has unique features of the mechanism of action in regards to inhibition of recruitment of transcriptional cofactors implicated in hypertrophic, proinflammatory, and profibrotic gene expression. Salient pharmacokinetic features like shorter half-life, insignificant drug-drug interactions, and not forming any major active metabolite have put the molecule far ahead of its other congener varieties. Pre-clinical and clinical studies have established the safety and efficacy of this molecule in the treatment of DKD. In spite of those results, issues like an appropriate time of initiation of the drug and clinical outcome as add-on therapy have to address on large-scale trial basis.