Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease: Clinical Evidence and Potential Adverse Events

Ashish Upadhyay; Lalarukh Haider

doi:10.2337/cd24-0036

Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease: Clinical Evidence and Potential Adverse Events

Clin Diabetes. 2024 Sep 20;43(1):43-52. doi: 10.2337/cd24-0036. eCollection 2025 Winter.

Authors

Ashish Upadhyay¹, Lalarukh Haider²

Affiliations

¹ Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA.
² UConn Health, University of Connecticut School of Medicine, Farmington, CT.

Abstract

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) globally and is associated with an increased risk of developing cardiovascular disease (CVD). DKD management requires a multipronged approach to decrease the progression of CKD and CVD. Mineralocorticoid receptor antagonists (MRAs) added to renin-angiotensin-aldosterone system blockade and sodium-glucose cotransporter 2 inhibitor therapy reduce the incidence of cardiovascular outcomes and progression of CKD. This review examines the cardiorenal benefits of MRAs and summarizes evidence on potential risks for acute kidney injury, hyperkalemia, and sexual dysfunction for steroidal and nonsteroidal MRAs.