Introduction:-
Diabetes is one of the most common causes of kidney failure. Diabetes is the presence of high blood sugar levels. It is caused by less insulin production or underutilization of insulin by the body. Insulin is the hormone produced by the pancreas that controls the blood sugar levels in the body. There are two types of diabetes, type 1 and type 2. Type 1 diabetes is also called insulin-dependent diabetes. Type 2 diabetes is non-insulin-dependent diabetes and is more common than type 1 diabetes. Diabetes injures the body's blood vessels, affecting the kidneys and other organs. High blood pressure and hardening of the blood vessels can cause heart disease.
Kidneys are essential in filtering waste and excess water from the system as urine. They control blood pressure as well. When the kidneys are harmed, they cannot filter blood leading to the accumulation of waste in the body; this causes several health problems. Higher blood glucose and high blood pressure damage the kidney blood vessels, thus causing kidney disease; this happens over a long time in case the diabetes is not controlled. Kidney disease caused by diabetes is known by several names, diabetic kidney disease, chronic kidney disease, or diabetic nephropathy. The kidneys have very small filters called glomeruli. Most of the filtration process takes place in the glomeruli. When there is high blood sugar, a lot of pressure builds up on these glomeruli. This overload starts to damage the filters over time. In due course, the filters release protein molecules from the body and the waste- albuminuria. These protein molecules actually should have been stored within the body.
How Does Type 2 Diabetes Cause Kidney Disease?
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Type 2 diabetes is the most important cause of chronic kidney disease worldwide.
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Studies have shown that stimulation of the mineralocorticoid receptor (MR)- ( for blood pressure and electrolyte regulation) can cause inflammation and fibrosis of the heart, kidneys, and blood vessels, thus leading to the progression of chronic kidney disease and cardiovascular disease.
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Heart failure leads to hospitalization and accounts for around seven percent of deaths. In patients with chronic kidney disease and type 2 diabetes, heart failure is a significant problem involving the patients and the health care system.
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Patients with heart failure, chronic kidney disease, and type 2 diabetes have an increased mortality risk.
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The severity of chronic kidney disease is also a risk factor.
What Is Finerenone and How Does It Work?
Finerenone is an innovative drug used to reduce the potential risk of kidney failure, heart attack, and heart failure in adults with kidney disease in patients with type 2 diabetes. It blocks the MR- mediated reabsorption of sodium and stimulation of MR. Finerenone has also been found to have anti-inflammatory and anti-fibrotic effects on the kidney and cardiovascular diseases. Several meta-analysis studies have been carried out to test the drug's efficacy.
These studies intended to:-
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Evaluate the effects of Finerenone on the occurrence of heart failure with type 2 diabetes and chronic kidney disease.
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To assess the effect of Finerenone on important heart failure outcomes.
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To evaluate the use of Finerenone by baseline history of heart failure, excluding patients with symptomatic heart failure.
The trials conducted were:-
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FIDELIO-DKD- Finerenone reduces kidney failure and disease progression in diabetic kidney disease. In FIDELIO-DKD, Finerenone reduced the kidney and cardiovascular outcome in individuals with stage three to four chronic kidney disease to a great extent. In FIGARO-DKD, Finerenone was found to reduce the risk of cardiovascular disease in a larger population than in FIDELIO-DKD. The FIDELIO-DKD trial was conducted to determine the effect of the treatment of Finerenone on kidney failures.
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FIGARO-DKD- Finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease is the phase III trial carried out on Finerenone. The FIGARO-DKD trial was conducted to find out the effect of Finerenone on the cardiovascular system. The efficiency and safety of Finerenone to avert chronic kidney disease in type 2 diabetes have not been thoroughly studied.
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FIDELITY- A combination of FIDELIO-DKD and FIGARO-DKD trials- FIDELITY aims to provide robust evidence on the efficiency and safety of Finerenone in individuals with chronic kidney disease in type 2 diabetes that was not obtained by both the trials separately.
These two trials are enormous heart and kidney outcome programs involving chronic kidney disease in type 2 diabetes. In addition, these trials studied the efficiency and safety of Finerenone on the kidney and cardiovascular system in individuals with established type 2 diabetes.
Albuminuria is a significant determinant of the progression of kidney disease. A decrease in protein excretion is a good sign of protection of kidney function. These studies have suggested that using Finerenone may help reduce albuminuria in chronic kidney disease patients. In addition, the incidence of kidney failure is lower in people using Finerenone.
What Are the Adverse Effects of Finerenone?
Increased Risk of Hyperkalemia - Hyperkalemia is the increase in potassium concentration. Increased sodium excretion from the body and decreased potassium excretion. Thus causing an increase in potassium concentration in the serum.
Acute Kidney Injury or Stroke - Most chronic kidney disease patients have been prescribed diabetic and blood pressure medications. However, Finerenone, combined with these drugs, can cause acute kidney injury or stroke.
In a nutshell, it has been found that patients with chronic kidney disease and type 2 diabetes who were given Finerenone had a lower risk of kidney failure, mortality from cardiovascular causes, heart attacks, stroke, or heart failure. Thus it suggests that for individuals with chronic kidney disease and type 2 diabetes, Finerenone may be used as a treatment modality to protect the kidneys and cardiovascular system.
Conclusion:
Various trials and studies have been conducted to test the efficacy of Finerenone in treating patients with chronic kidney disease in type 2 diabetes. Finerenone has been found to have an anti-albuminuric effect on patients with chronic kidney disease with less impact on the glomerular filtration rate. The significant side effect includes hyperkalemia or an increase in serum potassium levels. Apart from this, no other negative aspect has been reported. Furthermore, Finerenone has been found to lower the rate of occurrence of cardiovascular disorders in individuals with chronic kidney disease. Finerenone promises to be an effective treatment for chronic kidney disease in type 2 diabetic patients by reducing protein excretion in urine and protecting the cardiovascular system.
