FIDELIO study: significance and place of finerenone as nonsteroidal mineralocorticoid receptor antagonist in therapy of patients with chronic kidney disease in type 2 diabetes

Patients with diabetes mellitus and renal pathology are at high risk of developing end-stage kidney disease (ESKD) and cardiovascular disease (CVD), including atrial fibrillation as an life-threatening condition. The intense annual increase in patients with diabetes mellitus, mainly due to the patients with type 2 diabetes mellitus (T2D), and diabetic nephropathy sets a new goal for researchers to expand the range of drugs with cardio- and nephroprotective effects to offset the residual risks of development and progression of chronic kidney disease (CKD) and CVD in this cohort of patients. One of such drugs is finerenone — a novel selective non-steroidal mineralocorticoid receptor (MR) antagonist (MRA), hyperactivation of which mediates renal inflammation and fibrosis, cardiac remodeling and changes in its structural and electrical characteristics. This review presents the results of the sub-analysis of FIDELIO devoted to the mechanism of drug action, the finerenone efficacy evaluation, its comparison with the efficacy of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists with already proven organoprotective properties with respect to reducing the risk of renal and cardiovascular endpoints.

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