The potential role of finerenone in patients with type 1 diabetes and chronic kidney disease

Chronic kidney disease (CKD) represents a global health concern, associated with an increased risk of cardiovascular morbidity and mortality and decreased quality of life. Many patients with type 1 diabetes (T1D) will develop CKD over their lifetime. Uncontrolled glucose levels, which occur in patie...

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Veröffentlicht in:Diabetes, obesity & metabolism obesity & metabolism, 2024-10, Vol.26 (10), p.4135-4146
Hauptverfasser: Escobar Vasco, Maria Adelaida, Fantaye, Samuel H., Raghunathan, Sapna, Solis‐Herrera, Carolina
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container_end_page 4146
container_issue 10
container_start_page 4135
container_title Diabetes, obesity & metabolism
container_volume 26
creator Escobar Vasco, Maria Adelaida
Fantaye, Samuel H.
Raghunathan, Sapna
Solis‐Herrera, Carolina
description Chronic kidney disease (CKD) represents a global health concern, associated with an increased risk of cardiovascular morbidity and mortality and decreased quality of life. Many patients with type 1 diabetes (T1D) will develop CKD over their lifetime. Uncontrolled glucose levels, which occur in patients with T1D as well as type 2 diabetes (T2D), are associated with substantial mortality and cardiovascular disease burden. T2D and T1D share common pathological features of CKD, which is thought to be driven by haemodynamic dysfunction, metabolic disturbances, and subsequently an influx of inflammatory and profibrotic mediators, both of which are major interrelated contributors to CKD progression. The mineralocorticoid receptor is also involved, and, under conditions of oxidative stress, salt loading and hyperglycaemia, it switches from homeostatic regulator to pathophysiological mediator by promoting oxidative stress, inflammation and fibrosis. Progressive glomerular and tubular injury leads to macroalbuminuria a progressive reduction in the glomerular filtration rate and eventually end‐stage renal disease. Finerenone, a non‐steroidal, selective mineralocorticoid receptor antagonist, is approved for treatment of patients with CKD associated with T2D; however, the benefit of finerenone in patients with T1D has yet to be determined. This narrative review will discuss treatment of CKD in T1D and the potential future role of finerenone in this setting.
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Many patients with type 1 diabetes (T1D) will develop CKD over their lifetime. Uncontrolled glucose levels, which occur in patients with T1D as well as type 2 diabetes (T2D), are associated with substantial mortality and cardiovascular disease burden. T2D and T1D share common pathological features of CKD, which is thought to be driven by haemodynamic dysfunction, metabolic disturbances, and subsequently an influx of inflammatory and profibrotic mediators, both of which are major interrelated contributors to CKD progression. The mineralocorticoid receptor is also involved, and, under conditions of oxidative stress, salt loading and hyperglycaemia, it switches from homeostatic regulator to pathophysiological mediator by promoting oxidative stress, inflammation and fibrosis. Progressive glomerular and tubular injury leads to macroalbuminuria a progressive reduction in the glomerular filtration rate and eventually end‐stage renal disease. Finerenone, a non‐steroidal, selective mineralocorticoid receptor antagonist, is approved for treatment of patients with CKD associated with T2D; however, the benefit of finerenone in patients with T1D has yet to be determined. 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source Wiley Online Library Journals Frontfile Complete
subjects cardiovascular disease
Cardiovascular diseases
chronic kidney disease
Diabetes
Diabetes mellitus (insulin dependent)
Diabetes mellitus (non-insulin dependent)
Fibrosis
finerenone
Glomerular filtration rate
Hyperglycemia
Kidney diseases
Mineralocorticoid receptors
Morbidity
Mortality
Oxidative stress
Public health
Quality of life
Salt loading
type 1 diabetes
title The potential role of finerenone in patients with type 1 diabetes and chronic kidney disease
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