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    Home > Active Ingredient News > Endocrine System > To be good at work, one must first sharpen his tools——Professor Chen Nan talked about the new view of CKD combined with T2D treatment, Finerenone is expected to become a new treatment method

    To be good at work, one must first sharpen his tools——Professor Chen Nan talked about the new view of CKD combined with T2D treatment, Finerenone is expected to become a new treatment method

    • Last Update: 2021-10-11
    • Source: Internet
    • Author: User
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    Introduction Chronic kidney disease (CKD) is an increasingly popular disease in the world.
    The prevention and treatment of CKD in China is not optimistic.
    Diabetes has become one of the leading causes of CKD in China.
    Nearly 40% of patients with type 2 diabetes (T2D) will develop diabetes.
    Kidney disease (DKD), which is increasing with the sharp increase in the prevalence of diabetes, presents severe challenges from the perspective of clinical diagnosis and treatment¹
    .

    Although the existing treatment methods can alleviate the occurrence and development of CKD combined with T2D to a certain extent, the patient's prognosis is still unsatisfactory.
    There is a dual risk of kidney disease progression and cardiovascular death.
    The clinical application of new drugs is urgently needed
    .

    Following the 2021 annual meeting of the European Society of Cardiology (ESC), Yimaitong had the honor to interview Professor Nan Chen from the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, to discuss the current status, treatment concepts, research results and future development of CKD combined with T2D A detailed introduction is provided for readers
    .

    Prevention and treatment of CKD combined with T2D, the road is long and difficult, and the line is approaching
    .
    China is the world's largest diabetes country .

    Professor Chen Nan pointed out that there are approximately 120 to 130 million diabetic patients in China, and many of them have kidney damage
    .

    It is essential to strengthen the prevention and treatment of kidney disease
    .

    Whether early intervention can delay the progression of renal failure, reduce proteinuria, and prevent and treat the risk of cardiovascular events is a hot topic of clinical concern
    .

    Continue to go, the new generation of mineralocorticoid receptor antagonist Finerenone can be expected in the future.
    The results of Finerenone research are gratifying.
    "The FIDELITY and FIGARO-DKD research published at the ESC conference just past can be described as significant
    .

    "Professor Chen said excitedly
    .

    The FIGARO-DKD study was simultaneously published online in the New England Journal of Medicine (NEJM)², and there are some differences from the FIDELIO-DKD study ³ published last year: the population of subjects and the end points of the study are different.

    The
    former mainly included patients with mild-to-moderate CKD combined with T2D who were in the early stages of the disease course.
    The study focused on cardiovascular events, with kidney as a secondary study endpoint; while the latter mainly included patients with moderate-to-severe CKD combined with T2D who were in urgent need of clinical treatment.
    "These patients have relatively high proteinuria (>300mg/L) and decreased glomerular filtration rate (GFR).
    " Therefore, the renal complex event is the main endpoint of the study
    .

    "The results of the two studies show that Finerenone is very Outstanding effect, reduce proteinuria and improve GFR
    .

    One medicine is very inspiring for two organs
    .

    "Professor Chen's excitement is beyond words
    .

    Finerenone is likely to change the results of clinical management research .
    The management of Chinese patients with CKD and T2D may bring about earth-shaking changes
    .

    The drugs used in the past include renin-angiotensin system (RAS) blockers.
    , Such as angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor antagonist (ARB), in recent years, drugs such as sodium-glucose cotransporter 2 inhibitor (SGLT2i) have been published
    .

    And this conference was published.
    The researches of ”have given clinical good hints.
    I think that on the original basis, Finerenone can be combined with the above-mentioned drugs to better reduce proteinuria and improve renal function
    .

    ” Professor Chen said
    .

    Professor Chen also expressed his views on the replacement of mineralocorticoid receptor antagonists (MRA)
    .

    "In the past, only the first generation of MRA spironolactone was used as a diuretic
    .

    Later, the second generation of MRA eplerenone came out, which has a good anti-mineralocorticoid receptor (MR) effect
    .

    And Finerenone is the third generation of non-steroids.
    MRA has a stronger anti-MR effect, can better reduce proteinuria, block and delay the progression of renal failure
    .

    With the renewal of such drugs from generation to generation, we do feel that Finerenone will be used in the kidney field in the future Broad application prospects
    .

    "Professor Chen has unlimited expectations for this
    .

    The uniqueness of finerenone's mechanism of action With the in-depth understanding of the mechanism of CKD combined with T2D disease, the excessive activation of mineralocorticoid receptor (MR) can cause renal fibrosis and cause deterioration of renal function
    .
    ⁴⁻⁶ .

    Therefore, blocking MR overactivation is a new target for the treatment of CKD combined with T2D
    .

    "Finerenone has a very good effect on blocking the excessive activation of MR.
    It can significantly reduce proteinuria, effectively prevent renal fibrosis and cardiac fibrosis, delay the progression of renal function decline, reduce the occurrence of renal end-point events, and reduce cardiovascular The occurrence of end-point events
    .

    "Professor Chen once again affirmed the clinical role of Finerenone
    .

    The road is long and long, and I will search up and down for the management of kidney disease
    .
    The key is how to clinically find that the patient has kidney involvement .

    "There are about 120 to 130 million diabetic patients in China.
    Many of these diabetic patients have kidney damage.
    The earliest test for kidney damage is microalbuminuria.
    This is why recent studies have focused on microalbuminuria.

    .

    "Professor Chen stressed
    .

    "Whether it is CKD with diabetes, glomerulonephritis with diabetes, or simple diabetes directly leads to kidney damage, Finerenone has an important role in reducing proteinuria, whether it is mild proteinuria or severe proteinuria
    .

    " For the future Finerenone's expandable research direction and future prospects for the diagnosis and treatment of CKD combined with T2D, Professor Chen also put forward his own valuable opinions, "Many diabetic patients have a decline in GFR, and hyperglycemia may lead to an overestimation of GFR, and attention should be paid to the evaluation of high-risk factors
    .

    In addition, comprehensive management of blood sugar, blood lipids, uric acid, etc.
    should be strengthened, and urine protein assessment should be emphasized.
    Regardless of endocrine, kidney, and cardiovascular systems , it is a whole.
    Comprehensive comprehensive treatment will definitely improve the level of diagnosis and treatment
    .

    "For the application prospects of Finerenone, Professor Chen gave With high expectations, “Finerenone can expand research directions involving the kidney, cardiovascular, and neuroendocrine fields
    .
    The
    over-activation of MR leads to renal fibrosis, renal function involvement, and proteinuria, which reminds our doctors to pay attention to this pathway.
    , Combined with other pathways such as renin-angiotensin pathway, sympathetic nerve activation, etc.
    , "several prongs" may achieve better clinical results
    .
    The
    results of FIDELITY and FIGARO-DKD published by the ESC conference give This is a good reminder for us, and it also guides the direction of clinical treatment
    .

    "To sum up, the excessive activation of MR in diabetic patients can lead to renal function involvement, proteinuria, and renal and cardiac fibrosis
    .

    Finerenone has a very prominent role in reducing proteinuria, improving GFR, and reducing the risk of renal and cardiovascular complex events
    .

    Although Finerenone is not currently listed in China, its emergence provides a powerful means to control the progression of kidney disease earlier and to a greater extent! References: 1.
    AlicicRZ, Rooney MT, Tuttle KR, et al.
    Diabetic Kidney Disease: Challenges, Progress, and Possibilities[J].
    Clin J Am Soc Nephrol.
    2017;12(12):2032-2045.
    2.
    Pitt B, Filippatos G, AgarwalR, et al.
    Cardiovascular Events with Finerenone in Kidney Disease and Type 2Diabetes[J].
    N Engl J Med.
    2021 Aug28.
    doi: 10.
    1056/NEJMoa2110956.
    3.
    BakrisGL, Agarwal R,Anker SD, et al.
    Effect of Finerenone on Chronic Kidney DiseaseOutcomes in Type2 Diabetes.
    N Engl J Med.
    2020;383(23):2219-2229.
    4.
    Lytvyn Y, Godoy LC, Scholtes RA, et al.
    Mineralocorticoid Antagonism and Diabetic Kidney Disease.
    Curr Diab Rep.
    2019; 19(1):4.
    5.
    Barrera-Chimal J, Girerd S, Jaisser F.
    Mineralocorticoid receptor antagonists and kidney diseases: pathophysiologicalbasis.
    Kidney Int.
    2019;96(2):302-319.
    6.
    Yang P, Huang T, Xu G.

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