Aldosterone, secreted by the adrenal glands located above the kidneys, regulates salt and water in the body and plays a central role in controlling blood pressure. It is known that too much aldosterone can lead to high blood pressure, cardiovascular disease and kidney disease.
The Boston University team thus confirms that aldosterone plays a role in certain cardiac and vascular disorders. Finally, the risk of aggravation of renal insufficiency and its progression towards terminal insufficiency appears to be independent of whether or not the patients suffer from diabetes. The lead author of the study, Dr. Ashish Verma, professor at Boston University recalls recent randomized controlled trials which have shown that finerenone, used to treat heart failure is also effective in the treatment of diabetic nephropathy. and may delay the progression of chronic renal failure.
However, the role of aldosterone in renal failure has never been directly studied.
The possible beneficial action of finerenone
The drug targets a receptor, the mineralocorticoid receptors, which, when activated by aldosterone, promote high blood pressure, cardiovascular disease and kidney disease. While excessive aldosterone levels are very common, but usually undiagnosed, finerenone appears effective in reducing its elevated levels and thus the progression of kidney failure.
The study: the team here validates this hypothesis by evaluating the association between blood aldosterone concentrations and the progression of kidney disease in 3,680 patients aged 21 to 74, participating in the Chronic Renal Insufficiency Cohort study, conducted between 2003 and 2008 and followed over an average of 10 years. Progression of chronic renal failure defined as a 50% decrease in the ability of the kidneys to filter blood through blood vessels (estimated glomerular filtration rate – eGFR). During this period, kidney failure progressed in 1,412 or 38% of participants. The analysis reveals that:
- higher aldosterone concentrations are well associated with lower eGFR, lower blood potassium levels, and higher urine potassium and protein concentrations;
- following adjusting for possible confounders, such as medications, other medical conditions, age, ethnicity, height, and weight, each doubling of blood aldosterone concentrations is found to be related to a 11% increased risk of progression of renal failure;
- patients with concentrations in the top 25% have a 45% increased risk of chronic kidney disease vs. the 25% of patients with the lowest aldosterone concentrations;
- these risk levels are similar whether the patients are also diabetic or not; suggesting that aldosterone levels are an independent risk factor for chronic kidney disease.
This is the conclusion of the authors who provide here and also for the first time evidence of the mechanism by which mineralocorticoid receptor antagonists can delay the progression of renal failure – including in non-diabetic patients. The US Food and Drug Administration (FDA) has approved the use of finerenone for patients with chronic kidney disease and diabetes. A randomized controlled clinical trial is underway to validate the efficacy and safety of finerenone in non-diabetic renal failure patients.
Finally, the study suggests that aldosterone levels should be assessed in all patients at risk and/or in the presence of cardiorenal disease, particularly if they have central obesity and/or resistant hypertension.
