New Therapies for the Management of Chronic Kidney Disease

TL;DR

This paper explores new therapies for managing chronic kidney disease, particularly in patients with type 2 diabetes, focusing on potential advancements in pharmacological treatments.

Contribution

The paper introduces aldosterone synthase inhibitors as a potential new pillar in CKD management.

Findings

Aldosterone synthase inhibitors like vicadrostat show promise in reducing albuminuria and offering renal protection.

Incomplete aldosterone block remains a challenge in current CKD treatments.

Early-phase trials indicate potential benefits of ASIs in slowing kidney damage progression.

Abstract

A major public health concern gripping the nation is chronic kidney disease (CKD), and for individuals concomitantly diagnosed with type 2 diabetes mellitus (T2DM), the coexistence significantly increases the cardiovascular morbidity and mortality by two to three times higher than patients diagnosed without CKD. CKD management encompasses both non-pharmacological approaches, such as dietary sodium restriction and lifestyle modification for blood pressure control, and pharmacological approaches. Current pharmacological management focuses on four key pillars: renin-angiotensin system inhibitors (RASi), sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and mineralocorticoid receptor antagonists (MRAs), all of which have shown renoprotective and cardiovascular benefits. An incomplete block of aldosterone activity remains a challenge and is one of the factors contributing to the progression of kidney damage. Aldosterone synthase inhibitors (ASIs), such as vicadrostat, may represent a new horizon in selectively inhibiting aldosterone synthesis while preserving cortisol production. Early-phase trials have shown reductions in albuminuria and a potential for renal protection. The question is, could ASIs emerge as a fifth pillar in CKD management and help curb the progression?

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