Aldosteronantagonisten "revisited" [Aldosterone antagonists revisited]


  • J. Swolinsky
  • K. Schmidt-Ott


  • Nephrologe


  • Nephrologe 17: 239–245


  • Aldosterone and mineralocorticoid receptor (MR) activation are pathophysiologically involved in the development and progression of chronic kidney disease (CKD) by induction of fibrosis, inflammation and proteinuria. Clinical studies provide evidence that adding aldosterone antagonists (mineralocorticoid receptor antagonists, MRA) to the renin-angiotensin-aldosterone system (RAAS) block by angiotensin-converting enzyme inhibitors or angiotensin II receptor subtype 1 blockers reduces the incidence of adverse outcomes in CKD. In particular, two large multicenter trials have provided new evidence that the selective nonsteroidal MRA finerenone reduces adverse renal and cardiovascular outcomes with an acceptable risk profile for hyperkalemia in patients with type 2 diabetes and CKD. In contrast, the data situation is currently less clear regarding the use of the older MRA eplerenone and spironolactone and the role of MRA in patients with nondiabetic CKD. This article provides a review of the current trial data on cardioprotection and nephroprotection by MRA in CKD and reviews the evidence for each generation of MRA.