
Approximately 30%-40% of patients with type 1 or type 2 diabetes (T1D/T2D) develop diabetic kidney disease (DKD), which can lead to end-stage kidney disease (ESKD). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and sodium-glucose cotransporter 2 (SGLT2) inhibitors have been investigated as treatments for DKD. Finerenone, a novel and selective non-steroidal mineralocorticoid receptor antagonist (NS-MRA), was approved for treating patients with DKD and is associated with lower rates of hyperkalemia. Other NS-MRAs may also be effective drugs for the treatment of DKD. This review summarizes the effects of pharmacological MR blockade on diabetes and diabetes-associated CKD, focusing on the therapeutic mechanisms of NS-MRAs in preclinical and ongoing clinical studies.
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