Non-steroidal mineralocorticoid receptor antagonists in patients with chronic heart failure with reduced left ventricular ejection fraction and chronic kidney disease

Despite available treatment methods, combination of chronic heart failure with reduced left ventricular ejection fraction (HFrEF) and chronic kidney disease (CKD) is still associated with an extremely poor prognosis. According to the literature, spironolactone, the first mineralocorticoid receptor antagonist (MRA) recommended for HFrEF, not only fails to improve progression and prognosis of CKD, but also significantly increases the risk of hyperkalemia and mortality. Finerenone was developed as a new-generation MRA with acceptable risk of adverse events comparable to placebo. Large studies demonstrated a significant impact on course and prognosis of CKD in patients with type 2 diabetes mellitus and HF with moderately reduced and preserved left ventricular ejection fraction. However, there are no results from randomized clinical trials regarding combination of HFrEF and CKD. This review examines pathogenesis of chronic heart failure and kidney disease, where mineralocorticoid receptors have a central role. A comparative analysis of steroidal and nonsteroidal MRAs is presented from the perspective of CHF and CKD treatment.