diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13330diaendo-13330Research ArticleОБЗОРЫREVIEWSОрганопротективные возможности финеренона у пациентов с кардиоренометаболическим синдромомThe organoprotective effects of finerenone in patients with cardiorenal metabolic syndromehttps://orcid.org/0000-0002-0559-697XБабенкоА. Ю.BabenkoA. Y.

Бабенко Алина Юрьевна - д.м.н., профессор.

Санкт-Петербург

Alina Yu. Babenko - MD, PhD, Professor.

Saint Petersburg

alina_babenko@mail.ruhttps://orcid.org/0009-0002-9985-7946ЗасыпкинГ. Г.ZasypkinG. G.

Засыпкин Герман Георгиевич – аспирант.

197341, Санкт-Петербург, ул. Аккуратова, д. 2

German G. Zasypkin - MD, PhD student.

2 Akkuratova street, 197341 Saint Petersburg

germanzasypkin@yandex.ruНациональный медицинский исследовательский центр им. В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202524072025283284294Copyright © Бабенко А.Ю., Засыпкин Г.Г., 20252025Бабенко А.Ю., Засыпкин Г.Г.Babenko A.Y., Zasypkin G.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13330

Сахарный диабет 2 типа (СД2) сопровождается гиперактивацией ренин-альдостерон-ангиотензиновой системы (РААС) и повышенной концентрацией альдостерона в крови, что приводит к развитию и прогрессированию хронической болезни почек (ХБП) и хронической сердечной недостаточности (ХСН). Высокие уровни альдостерона, усиливая инсулинорезистентность, вызывают нарушение микроциркуляции, митохондриальную дисфункцию, окислительный стресс, воспаление, дислипидемию и в итоге фиброз. Кроме того, у пациентов с СД2 в условиях персистирующего окислительного стресса и гипергликемии, даже в отсутствие избытка альдостерона или кортизола, запускается процесс патологической гиперактивации минералокортикоидных рецепторов (МКР), замыкающий порочный круг и усиливающий воспалительные и фиброзные изменения в сердце и почках пациента. В этой связи таргетная блокада МКР наиболее актуальна для снижения активности фиброза — наименее обратимого изменения при ХБП и ХСН. Однако спиронолактон не является строго селективным антагонистом МКР, что обуславливает множество его побочных эффектов, а эплеренон, обладая большей селективностью, имеет более низкое сродство к МКР, что обуславливает его более слабый кардиопротективный эффект. Финеренон — первый нестероидный антагонист МКР, рекомендуемый для лечения ХБП (с альбуминурией) у взрослых пациентов с СД2, обеспечивает наиболее выраженный противовоспалительный и антифиброзный эффект и не обладает побочными эффектами стероидных антагонистов МКР.

Целью настоящего обзора стала оценка результатов клинических исследований влияния финеренона на сердечно-сосудистые и почечные события у пациентов с СД2. В обзоре представлена и проанализирована актуальная информация о влиянии финеренона на сердечно-сосудистые и почечные события у пациентов с СД2. Систематизированы и описаны дополнительные положительные кардиопротективные эффекты при применении финеренона.

Type 2 diabetes mellitus (T2DM) is associated with hyperactivity of the renin-angiotensin-aldosterone system (RAAS), leading to increased aldosterone levels in the blood. This can result in the development and progression of chronic kidney disease (CKD) and congestive heart failure (CHF). High aldosterone levels, in turn, contribute to insulin resistance, microcirculatory disorders, mitochondrial dysfunction, oxidative stress, inflammation, dyslipidemia, and fibrosis. Additionally, in T2DM patients, persistent oxidative stress and hyperglycemia can trigger pathological activation of mineralocorticoid receptors, even in the absence of aldosterone or cortisol. This results in a vicious cycle of inflammation and fibrosis in the heart and kidneys.

Therefore, targeting mineralocorticoid receptor (MCR) blockade is crucial for reducing fibrosis and other irreversible changes in CKD and CHF, as it can help break this cycle and reduce inflammation and fibrosis. However, spironolactone is not a highly selective MKR antagonist, which is one of the reasons for its many side effects. Eplerenone, with greater selectivity and lower affinity for the MKR, has a weaker cardioprotective effect due to its lower affinity. Finerenone, a first-in-class nonsteroidal mineralocorticoid receptor antagonist indicated for the treatment of CKD with albuminuria in adult patients with T2DM, provides the most significant anti-inflammatory and antifibrotic effects without the side effects associated with steroidal anti-inflammatory medications.

The aim of this review is to evaluate the clinical trial results on the effects of finerenone on cardiovascular and renal outcomes in patients with T2DM. The review provides an up-to-date overview of the current literature on the impact of finerenone on these outcomes and systematically summarizes and describes additional positive cardioprotective benefits associated with its use.

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The authors declare that there are no conflicts of interest present.