Starting from the "heart", Professor Ma Changsheng talks about the current status of T2D combined with CKD treatment. The star drug Finerenone is expected to become a new therapeutic tool

Cardiovascular disease (CVD) is the main cause of death and disability in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) [1]
.

At present, the number of diabetes patients in China is as high as 130 million, and epidemiological studies have shown that 52.
3% of hospitalized T2D patients in China have CKD.
T2D combined with CKD has become a major problem in the field of cardiovascular disease prevention and treatment in China [1,2]
.

Therefore, cardiologists should pay more attention to patients with T2D and CKD, and strengthen the management and treatment of cardiovascular risks in such patients
.

Following the European Society of Cardiology (ESC) 2021 annual meeting, Yimaitong had the honor to interview Professor Ma Changsheng, the chairman-elect of the Cardiovascular Branch of the Chinese Medical Association and the director of the Cardiology Center of Beijing Anzhen Hospital, Capital Medical University, about the merger of T2D The current status and future development of CKD diagnosis and treatment are introduced in detail for readers
.

The burden of CKD combined with T2D is serious, and clinical management is urgently needed.
In recent years, patients with T2D combined with CKD have a serious burden of disease, which can lead to hypertension, heart failure, water and sodium retention, etc.
, which seriously affect the prognosis of patients
.

Studies have shown that compared with T2D patients without CKD, the cardiovascular mortality of T2D patients with CKD is significantly increased (19.
6% vs.
6.
7%) [3]
.

How to reduce the risk of cardiovascular events in patients with T2D and CKD, while taking into account kidney protection, delaying the progression of CKD to end-stage renal disease (ESRD), thereby improving the quality of life of patients and reducing the mortality rate is a huge challenge and test currently facing
.

"To manage diabetes well is to manage all related factors, not just blood sugar
.

"Professor Ma Changsheng pointed out, "The most important thing is to improve the patient's life>
.

At the same time, in terms of treatment, blood pressure, blood lipids, kidney function and other aspects need to be given more rigorous treatment
.

"From research to clinical, Finerenone fills the gap in the treatment field.
Two major studies of Finerenone-FIGARO-DKD and FIDELITY-were released at this year's ESC conference.
The results showed that Finerenone significantly reduced the first occurrence of cardiovascular disease in patients with T2D combined with mild to moderate CKD.
The combined risk of death or non-fatal events (cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure) is 13% (hazard ratio [HR] 0.
87; 95% CI 0.
76-0.
98; p=0.
03); in addition Finerenone can reduce the renal composite endpoint of a sustained decrease of ≥57% (creatinine doubled) of eGFR by 23% (HR=0.
77, 95%CI 0.
60-0.
99), the difference is statistically significant (P=0.
041)
.

This is exciting.
The results strongly prove the protective effects of Finerenone on the heart and kidneys of T2D patients with CKD, and are complementary to the FIDELIO-DKD results previously published in the New England Journal of Medicine, and fully demonstrate that Finerenone can effectively reduce cardiovascular-related deaths.
And the occurrence of cardiovascular events and delayed renal function decline
.

Professor Ma said, “This study is a breakthrough study that we have rarely encountered in recent years.
The sufficient sample size and conclusions can support our application of the new drug Finerenone
.

"From mechanism to practice, Finerenone is unique.
With the in-depth study of the mechanism of T2D combined with CKD, excessive activation of mineralocorticoid receptor (MR) has become one of the key driving factors for adverse cardiovascular outcomes and kidney disease in T2D combined with CKD.
One
.

Excessive activation of MR can promote inflammation, cause myocardial cell damage, myocardial remodeling and fibrosis, and cause heart failure, malignant arrhythmia, myocardial infarction and other adverse clinical outcomes
.

Therefore, blocking MR overactivation is a potential therapeutic target for T2D combined with CKD[4,5]
.

Finerenone is a new generation of non-steroidal highly selective mineralocorticoid receptor antagonist (MRA), which can effectively block the damage to target organs such as the heart, kidney and blood vessels caused by over-activation of MR.
It is safe while ensuring the effectiveness of treatment.

.

Professor Ma emphasized, “The mechanism of action of Finerenone is different from the first-generation MRA spironolactone and the second-generation MRA eplerenone.
For the binding and selectivity of MR, Finerenone has better selectivity and better binding rate.
The mechanism is significantly better than spironolactone and eplerenone
.

” Because of this, “Finerenone’s adverse events such as hyperkalemia and gynecomastia may be greatly reduced, and the patient’s medication compliance will be greatly improved.
I believe Finerenone will be widely used in clinical practice!" Professor Ma added
.

Finerenone is expected to write a new chapter in the treatment of T2D combined with CKD.
Professor Ma also put forward his own views on the cardiovascular risk management and treatment of patients with T2D combined with CKD
.

"At present, clinicians have paid more and more attention to comprehensive management.
For example, endocrinologists are becoming more and more good at managing patients with hypertension, coronary heart disease, and heart failure
.
In
cardiology, about 25% of patients have diabetes, which is a huge group
.

" Ma The professor emphasized
.

Cardiologists have gradually realized the risk of cardiovascular disease in patients with diabetes and kidney disease, and will strengthen the standardized treatment of diabetes and kidney disease, and also pay attention to the screening and management of cardiovascular disease in such patients
.

Speaking of Finerenone, Professor Ma spoke highly of it, “Once more studies prove that this drug can improve the prognosis of patients with diabetes and nephropathy, clinicians will easily accept the test results
.

Then, the relevant guidelines in this disease field may also be updated quickly.
, So as to further guide clinicians in the clinical practice of patients with diabetes and kidney disease and increase the importance of cardiovascular risk management for such patients, and to reduce atherosclerotic cardiovascular disease (ASCVD) caused by diabetes and delay kidney disease The progress of the disease is also of great benefit!” Conclusion The burden of cardiovascular disease in China is increasing day by day.
Diabetes and CKD are independent risk factors for cardiovascular disease, and comprehensive prevention and treatment of cardiovascular disease is essential
.

Cardiologists should increase the importance and awareness of diagnosis and treatment of patients with T2D and CKD, and strengthen the prevention and management of cardiovascular events and standardized treatment of heart and kidney
.

In addition, clinical multidisciplinary communication and cooperation should be strengthened, and the comprehensive evaluation, diagnosis and treatment of patients with T2D and CKD should be carried out together with the renal and endocrine colleagues, and the comprehensive management level of patients with T2D and CKD should be improved
.

The FIDELITY and FIGARO-DKD research results released by the ESC conference this year have given clinical good hints and guided the direction of clinical treatment, confirming that Finerenone can significantly reduce the risk of cardiovascular and renal complex events
.

The emergence of Finerenone provides a new method for the management and prevention of cardiovascular risk in patients with T2D and CKD, which can further delay renal failure, prevent adverse cardiovascular outcomes, and bring both heart and kidney benefits
.

The clinic expects that the drug will be launched in China as soon as possible, adding another “weapon” to the cardiovascular risk management and prevention of patients with T2D combined with CKD in my country! References: 1.
Sun Yihong, et al.
Chinese Journal of Internal Medicine.
2021; 60(5): 421-437.
2.
Xu Jie, et al.
Chinese Journal of Endocrinology and Metabolism.
2014; 30(7): 597-600.
3.
Maryam Afkarian, et al.
J Am Soc Nephrol.
2013 Feb; 24 (2): 302-8.
4.
Guo Xiying, et al.
Cardiovascular Disease Progress.
2020; 41 (10): 1021-2025.
5.
Jason L Guichard, et al.
Vasc Health RiskManag.
2013; 9: 321-31.